Margin marking before colorectal endoscopic mucosal resection and its impact on neoplasia recurrence (with video)

Published:November 29, 2021DOI:https://doi.org/10.1016/j.gie.2021.11.023

      Background and Aims

      Ablation of resection margins after EMR of large nonpedunculated colorectal polyps decreases recurrence. Margin marking before EMR (EMR-MM) may represent an alternative method to achieve a healthy resection margin. We aimed to determine the efficacy of EMR-MM in reducing neoplasia recurrence.

      Methods

      We conducted a single-center historical control study of EMR cases (EMR-MM vs conventional EMR) for nonpedunculated polyps ≥20 mm between 2016 and 2021. For EMR-MM, cautery marks were placed along the lateral margins of the polyp with the snare tip. EMR was then performed to include resection of the healthy mucosa containing the marks. We compared recurrence at surveillance colonoscopy after EMR-MM versus historical control subjects. Multivariable logistic regression was performed to identify factors associated with recurrence.

      Results

      Two hundred ten patients with 210 polyps (median size, 30 mm; interquartile range: 25-40) underwent EMR-MM (n = 74) or conventional EMR (n = 136). Patient and lesion characteristics were similar between the groups. At a median follow-up of 6 months, the recurrence rate was lower with EMR-MM (6/74; 8%) compared with historical control subjects (39/136; 29%) (P < .001). EMR-MM was not associated with an increased rate of adverse events. On multivariable analysis, EMR-MM remained the strongest predictor of recurrence (odds ratio, .20; 95% confidence interval, .13-.64; P = .003) aside from polyp size (odds ratio, 2.81; 95% confidence interval, 1.35-6.01; P = .008).

      Conclusions

      In this single-center historical control study, EMR-MM of large nonpedunculated colorectal polyps reduced the recurrence risk by 80% when compared with conventional EMR. This simple technique may provide an alternative to margin ablation.

      Abbreviations:

      EMR-MM (EMR with margin marking before resection), ESD (endoscopic submucosal dissection), IQR (interquartile range), OR (odds ratio), SC (surveillance colonoscopy)
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      Linked Article

      • Connecting the dots to eliminate recurrence after endoscopic mucosal resection in the colon
        Gastrointestinal EndoscopyVol. 95Issue 5
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          Innovations in EMR over the past decade have solidified its position as the preferred first-line intervention for large (≥20 mm) non-pedunculated colorectal polyps (LNPCPs). Careful optical assessment and lesion selection, together with technologic advances, have allowed the safe and effective removal of LNPCPs without features of submucosal invasive cancer by EMR. The major historical limitations of EMR, including intraprocedural bleeding, clinically significant post-EMR bleeding, recognition and treatment of deep mural injury, and the removal of lesions in difficult locations (ileocecal valve and anorectal junction), have all been largely overcome by scientific study.
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