Original article Clinical endoscopy| Volume 93, ISSUE 3, P699-703, March 2021

Colorectal EMR outcomes in octogenarians versus younger patients referred for removal of large (≥20 mm) nonpedunculated polyps

Published:October 16, 2020DOI:

      Background and Aims

      Data are limited on safety and outcomes of colorectal EMR in octogenarians (≥80 years old). We sought to review outcome data for patients aged ≥80 in a prospectively collected database of patients referred for large polyp removal.


      We retrospectively evaluated a database of patients referred for large (≥20 mm) nonpedunculated polyp removal. From 2000 to 2019, we compared the rates of follow-up, recurrence, adverse events, and synchronous neoplasia detection between younger patients and patients aged ≥80.


      There were 167 patients aged ≥80 years and 1686 <80 years. Patients in the elderly group returned for surveillance less often (67.1% vs 75.1%, P = .024), had greater first follow-up recurrence rates (27.5% vs 13.8%, P < .001), but had similar adverse event rates (1.8% vs 2.8%, P = .619) compared with younger patients. Rates of synchronous neoplasia were similar and high in both groups.


      EMR is safe and well tolerated for large polyp removal in patients over 80 years old. Patients aged ≥80 years are less likely to present for follow-up after EMR. They had a higher recurrence rate and a similarly high prevalence of synchronous precancerous lesions. Follow-up after EMR should be encouraged in the elderly, and an attempt to clear the colon of synchronous disease at the time of the initial EMR may be warranted.


      APC (argon plasma coagulation), HGD (high-grade dysplasia)
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        • Kaltenbach T.
        • Anderson J.C.
        • Burke C.A.
        • et al.
        Endoscopic removal of colorectal lesions-recommendations by the US Multi-Society Task Force on Colorectal Cancer.
        Gastrointest Endosc. 2020; 91: 486-519
        • Yu J.X.
        • Lin J.L.
        • Oliver M.
        • et al.
        Trends in endoscopic mucosal resection for nonmalignant colorectal polyps in the United States.
        Gastrointest Endosc. 2020; 91: 124-131
        • Moss A.
        • Bourke M.J.
        • Williams S.J.
        • et al.
        Endoscopic mucosal resection outcomes and prediction of submucosal cancer from advanced colonic mucosal neoplasia.
        Gastroenterology. 2011; 140: 1909-1918
        • Soetikno R.M.
        • Gotoda T.
        • Nakanishi Y.
        • et al.
        Endoscopic mucosal resection.
        Gastrointest Endosc. 2003; 57: 567-579
        • Rao A.K.
        • Soetikno R.
        • Raju G.S.
        • et al.
        Large sessile serrated polyps can be safely and effectively removed by endoscopic mucosal resection.
        Clin Gastroenterol Hepatol. 2016; 14: 568-574
        • Pontone S.
        • Palma R.
        • Panetta C.
        • et al.
        Endoscopic mucosal resection in elderly patients.
        Aging Clin Exp Res. 2017; 29: 109-113
        • Corley D.A.
        • Jensen C.D.
        • Marks A.R.
        • et al.
        Variation of adenoma prevalence by age, sex, race, and colon location in a large population: implications for screening and quality programs.
        Clin Gastroenterol Hepatol. 2013; 11: 172-180
        • Rim S.H.
        • Seeff L.
        • Ahmed F.
        • et al.
        Colorectal cancer incidence in the United States, 1999-2004: an updated analysis of data from the National Program of Cancer Registries and the Surveillance, Epidemiology, and End Results Program.
        Cancer. 2009; 115: 1967-1976
        • Brenner H.
        • Hoffmeister M.
        • Stegmaier C.
        • et al.
        Risk of progression of advanced adenomas to colorectal cancer by age and sex: estimates based on 840,149 screening colonoscopies.
        Gut. 2007; 56: 1585-1589
        • Lang B.M.
        • Kuipers J.
        • Misselwitz B.
        • et al.
        Predicting colorectal cancer risk from adenoma detection via a two-type branching process model.
        PLoS Comput Biol. 2020; 16e1007552
        • Mitchell R.A.
        • Zhang C.
        • Galorport C.
        • et al.
        Characteristics of patients with colonic polyps requiring segmental resection.
        Can J Gastroenterol Hepatol. 2018; 20187046385
        • Ferlitsch M.
        • Moss A.
        • Hassan C.
        • et al.
        Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline.
        Endoscopy. 2017; 49: 270-297
        • Gomez V.
        • Racho R.G.
        • Woodward T.A.
        • et al.
        Colonic endoscopic mucosal resection of large polyps: Is it safe in the very elderly?.
        Dig Liver Dis. 2014; 46: 701-705
        • Xie H.Q.
        • Zhong W.Z.
        Outcomes of colonic endoscopic mucosal resection for large polyps in elderly patients.
        J Laparoendosc Adv Surg Tech A. 2016; 26: 707-709
        • Lippert E.
        • Herfarth H.H.
        • Grunert N.
        • et al.
        Gastrointestinal endoscopy in patients aged 75 years and older: risks, complications, and findings—a retrospective study.
        Int J Colorectal Dis. 2015; 30: 363-366
        • Jafri S.M.
        • Monkemuller K.
        • Lukens F.J.
        Endoscopy in the elderly: a review of the efficacy and safety of colonoscopy, esophagogastroduodenoscopy, and endoscopic retrograde cholangiopancreatography.
        J Clin Gastroenterol. 2010; 44: 161-166
        • Bronsgeest K.
        • Huisman J.F.
        • Langers A.
        • et al.
        Safety of endoscopic mucosal resection (EMR) of large non-pedunculated colorectal adenomas in the elderly.
        Int J Colorectal Dis. 2017; 32: 1711-1717
        • Bick B.L.
        • Ponugoti P.L.
        • Rex D.K.
        High yield of synchronous lesions in referred patients with large lateral spreading colorectal tumors.
        Gastrointest Endosc. 2017; 85: 228-233
        • Klein A.
        • Tate D.J.
        • Jayasekeran V.
        • et al.
        Thermal ablation of mucosal defect margins reduces adenoma recurrence after colonic endoscopic mucosal resection.
        Gastroenterology. 2019; 156: 604-613
        • Repici A.
        • Wallace M.
        • Sharma P.
        • et al.
        A novel submucosal injection solution for endoscopic resection of large colorectal lesions: a randomized, double-blind trial.
        Gastrointest Endosc. 2018; 88: 527-535
        • Sportes A.
        • Jung C.F.M.
        • Gromski M.A.
        • et al.
        Novel modified endoscopic mucosal resection of large GI lesions (> 20 mm) using an external additional working channel (AWC) may improve R0 resection rate: initial clinical experience.
        BMC Gastroenterol. 2020; 20: 195
        • Raju G.S.
        • Lum P.
        • Abu-Sbeih H.
        • et al.
        Cap-fitted endoscopic mucosal resection of >/= 20 mm colon flat lesions followed by argon plasma coagulation results in a low adenoma recurrence rate.
        Endosc Int Open. 2020; 8: E115-E121
        • Pellise M.
        • Burgess N.G.
        • Tutticci N.
        • et al.
        Endoscopic mucosal resection for large serrated lesions in comparison with adenomas: a prospective multicentre study of 2000 lesions.
        Gut. 2017; 66: 644-653
        • Buchner A.M.
        • Guarner-Argente C.
        • Ginsberg G.G.
        Outcomes of EMR of defiant colorectal lesions directed to an endoscopy referral center.
        Gastrointest Endosc. 2012; 76: 255-263
        • Burgess N.G.
        • Metz A.J.
        • Williams S.J.
        • et al.
        Risk factors for intraprocedural and clinically significant delayed bleeding after wide-field endoscopic mucosal resection of large colonic lesions.
        Clin Gastroenterol Hepatol. 2014; 12: 651-661
        • Kumar V.
        • Broadley H.
        • Rex D.K.
        Safety and efficacy of hot avulsion as an adjunct to EMR (with videos).
        Gastrointest Endosc. 2019; 89: 999-1004
        • Veerappan S.G.
        • Ormonde D.
        • Yusoff I.F.
        • et al.
        Hot avulsion: a modification of an existing technique for management of nonlifting areas of a polyp (with video).
        Gastrointest Endosc. 2014; 80: 884-888
        • Holmes I.
        • Kim H.G.
        • Yang D.H.
        • et al.
        Avulsion is superior to argon plasma coagulation for treatment of visible residual neoplasia during EMR of colorectal polyps (with videos).
        Gastrointest Endosc. 2016; 84: 822-829
        • Peery A.F.
        • Shaheen N.J.
        • Cools K.S.
        • et al.
        Morbidity and mortality after surgery for nonmalignant colorectal polyps.
        Gastrointest Endosc. 2018; 87: 243-250