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Original article Clinical endoscopy| Volume 85, ISSUE 3, P647-656.e6, March 2017

Adenoma recurrence after piecemeal colonic EMR is predictable: the Sydney EMR recurrence tool

Published:November 28, 2016DOI:https://doi.org/10.1016/j.gie.2016.11.027
Adenoma recurrence after piecemeal colonic EMR is predictable: the Sydney EMR recurrence tool
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      Background and Aims

      EMR is the primary treatment of large laterally spreading lesions (LSLs) in the colon. Residual or recurrent adenoma (RRA) is a major limitation. We aimed to identify a robust method to stratify the risk of RRA.

      Methods

      Prospective multicenter data on consecutive LSLs ≥20 mm removed by piecemeal EMR from 8 Australian tertiary-care centers were included (September 2008 until May 2016). A logistic regression model for endoscopically determined recurrence (EDR) was created on a randomly selected half of the cohort to yield the Sydney EMR recurrence tool (SERT), a 4-point score to stratify the incidence of RRA based on characteristics of the index EMR. SERT was validated on the remainder of the cohort.

      Results

      Analysis was performed on 1178 lesions that underwent first surveillance colonoscopy (SC1) (median 4.9 months, interquartile range [IQR] 4.9-6.2). EDR was detected in 228 of 1178 (19.4%) patients. LSL size ≥40 mm (odds ratio [OR] 2.47; P < .001), bleeding during the procedure (OR 1.78; P = .024), and high-grade dysplasia (OR 1.72; P = .029) were identified as independent predictors of EDR and allocated scores of 2, 1, and 1, respectively to create SERT. Lesions with SERT scores of 0 (SERT = 0) had a negative predictive value of 91.3% for RRA at SC1, and SERT was shown to stratify RRA to specific follow-up intervals by using Kaplan Meier curves (log-rank P < .001).

      Conclusions

      Guidelines recommend SC1 within 6 months of EMR. SERT accurately stratifies the incidence of RRA after EMR. SERT = 0 lesions could safely undergo first surveillance at 18 months, whereas lesions with SERT scores between 1 and 4 (SERT 1-4) require surveillance at 6 and 18 months. (Clinical trial registration number: NCT01368289.)

      Abbreviations:

      EDR (endoscopically determined recurrence), HDR (histologically determined recurrence), LSL (laterally spreading lesion), RRA (residual or recurrent adenoma), SC1 (first surveillance colonoscopy after EMR), SERT (Sydney EMR recurrence tool)
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      Article info

      Publication history

      Published online: November 28, 2016
      Accepted: November 23, 2016
      Received: September 14, 2016

      Footnotes

      DISCLOSURE: D. Tate received a scholarship from the Westmead Medical Research Foundation. These funds were not used for this study. The Cancer Institute New South Wales provided funding for a research nurse and data manager to assist with the administration of the study. There was no influence from the Institution regarding study design or conduct, data collection, management, analysis or interpretation, preparation, review, or approval of the manuscript. All other authors disclosed no financial relationships relevant to this publication.

      See CME section; p. 677.

      If you would like to chat with an author of this article, you may contact Dr Bourke at [email protected]

      Identification

      DOI: https://doi.org/10.1016/j.gie.2016.11.027

      Copyright

      © 2017 by the American Society for Gastrointestinal Endoscopy

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