Original article Clinical endoscopy| Volume 91, ISSUE 1, P124-131.e4, January 2020

Trends in EMR for nonmalignant colorectal polyps in the United States

Published:August 19, 2019DOI:

      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.


      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.


      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).


      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.


      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)
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      Linked Article

      • 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
        • Preview
          Most 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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