Background and Aims
Although most large nonpedunculated colorectal lesions can be safely and efficaciously
removed using EMR, the use of colectomy for benign colorectal lesions appears to be
increasing. The reason(s) is unclear. We aimed to determine the use and adverse events
of EMR in the United States.
Methods
We used Optum’s de-identified Clinformatics Data Mart Database (2003-2016), a database
from a large national insurance provider, to identify all colonoscopies performed
with either EMR or simple polypectomy on adult patients from January 1, 2011 to December
31, 2015. We measured time trends, regional variation, and adverse event rates. We
assessed risk factors for adverse events using multivariate logistic regression.
Results
The rate of EMR use in the US increased from 1.62% of all colonoscopies in 2011 to
2.48% of colonoscopies in 2015 (P < .001). There were, however, significant regional differences in the use of EMRs,
from 2.4% of colonoscopies in the western United States to 2.0% of colonoscopies in
the southern United States. Between 2011 and 2015, we found stable rates of perforation,
GI bleeding (GIB), infections, and cardiac adverse events and decreasing rates of
admissions after EMR. In our multivariate model, EMR was an independent risk factor
for adverse events, albeit the rates of adverse events were low (1.35% GIB, .22% perforation).
Conclusions
Use of EMR is rising in the United States, although there is significant regional
variation. The rates of adverse events after EMR and polypectomies were low and stable,
confirming the continued safety of EMR procedures. A better understanding of the regional
barriers and facilitators may improve the use of EMR as the standard management for
benign colorectal lesions throughout the United States.
Abbreviations:
CCI (Charlson comorbidity index), CI (confidence interval), CPT (Current Procedural Terminology), GIB (GI bleeding), ICD-9 (International Classification of Diseases Codes), 9th revision (ICD-10), International Classification of Diseases Codes (10th revision), IQR (interquartile range), OR (odds ratio)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 19, 2019
Accepted:
August 5,
2019
Received:
April 1,
2019
Footnotes
DISCLOSURE: The following authors received research support for this study from the National Institutes of Health: J. X. Yu (2T32 DK 00705642), A. J. Kwong (KL2 TR 001083), and J. L. Lin (KL2 TR 001083 and UL1 TR 001085E). In addition, the following authors disclosed financial relationships relevant to this publication: R. Soetikno: Consultant for Olympus; T. Kaltenbach: Consultant for Olympus and Aries Pharmaceutical. All other authors disclosed no financial relationships relevant to this publication. Research support for this study was provided by a National Institutes of Health National Center for Advancing Translational Science Clinical and Translational Science Award (UL1 TR001085) and internal Stanford funding. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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- What can colonoscopists do now to move management of large benign laterally spreading lesions in the colorectum from surgery to EMR?Gastrointestinal EndoscopyVol. 91Issue 1
- PreviewMost expert colonoscopists in the United States consider EMR to be the first-line treatment for nearly all large (≥20 mm diameter), benign, flat, and sessile colorectal lesions. Flat and sessile lesions >10 mm in diameter are often called laterally spreading lesions (LSLs). The evidence that endoscopic resection is “better” than surgical resection for benign LSLs does not come from randomized controlled trials. Rather, large series show that the mortality, morbidity, and costs of surgical resection are substantially higher than those of EMR,1-3 whereas long-term eradication rates after EMR are very high.
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