Authors I. CHAOUI (1), I. DEMEDTS (1), P. ROELANDT (1), H. WILLEKENS (1), R. BISSCHOPS (1) / [1] University Hospital Gasthuisberg, Leuven, Belgium, Gastroenterology and Hepatology
Introduction Endoscopic mucosal resection (EMR) is currently the first-line treatment for large sessile and flat colorectal polyps in Western centres. However, adenoma recurrence after EMR continues to be a challenge. Here we present the results on outcome, recurrence and adverse events of EMR of large sessile and flat colorectal polyps in a Belgian series.
Aim The aim of this study is to assess the efficacy, safety and recurrence rate of EMR in a tertiary centre and to identify risk factors associated with local recurrence during first surveillance endoscopy (SE1).
Methods We performed a retrospective study of 165 sessile and flat colorectal lesions measuring ≥15 mm, treated by EMR from October 2017 to October 2019. Subsequent colonoscopy and pathology reports were reviewed until October 2020 to identify recurrence. We used multivariate logistic regression to identify independent risk factors for recurrence at SE1.
Results EMR was performed for 165 colorectal polyps in 142 patients and successful resection was achieved in 158 cases (95,2%). SE1 data was available for 117 of 135 eligible cases (86,7%) after a median time of 6,2 months (IQR 5-9,9), and showed recurrent adenoma in 19 cases (16,2%). Recurrence was mainly treated endoscopically (78,9%) by EMR, polypectomy or biopsy avulsion. Three patients (15,8%) underwent surgery and one elected a conservative approach due to age and comorbidity. SE2 was available for 16 cases after a median time of 12,9 months (IQR 11,7-18,2). Persisting adenoma was found in 2 of 3 available cases after endoscopic treatment at SE1. These were managed by polypectomy or surgery. All 13 available cases without recurrence at SE1 remained free of adenoma at SE2. Independent risk factors for recurrence at SE1 were lesion size ≥ 40 mm (odds ratio [OR] 4,03; p = 0,018) and presence of high-grade dysplasia (OR 3,89; p = 0,034). Early adverse event occurred in 4 patients (2,4%) and consisted of 3 bleeding complications and 1 perforation. Twelve patients (7,2%) presented with delayed bleeding of which 3 required transfusion, with radiological intervention in one case. All other complications were managed either conservatively (n = 8) or endoscopically (n = 5) with various combinations of clipping, snare tip soft coagulation, BICAP cautery and submucosal adrenalin injection.
Conclusions EMR is a safe and effective treatment for large sessile and flat colorectal lesions with low recurrence rates. Lesion size ≥ 40 mm and presence of HGD were identified as risk factors for early recurrence, highlighting the importance of compliance to follow-up in these cases.
