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. 2020 Jan;91(1):124-131.e4.
doi: 10.1016/j.gie.2019.08.004. Epub 2019 Aug 19.

Trends in EMR for nonmalignant colorectal polyps in the United States

Jessica X Yu  1 , Jody L Lin  2 , Melissa Oliver  3 , Roy Soetikno  4 , Matthew S Chang  5 , Allison J Kwong  1 , Berkeley N Limketkai  1 , Jay Bhattacharya  6 , Tonya Kaltenbach  7
Affiliations

Trends in EMR for nonmalignant colorectal polyps in the United States

Jessica X Yu et al. Gastrointest Endosc. 2020 Jan.

Abstract

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.

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Figures

Figure 1.
Figure 1.
Frequency of colonoscopies and proportions of EMR performed, by year. Frequency of colonoscopies has increased from 233,443 in 2011 to 440,981 in 2016 (p=0.004). Proportion of EMR have increased from 1.62% of colonoscopies in 2011 to 2.48% of colonoscopies in 2015, p<0.001.
Figure 2.
Figure 2.
Proportion of EMR performed per 100 colonoscopies, by state.
Figure 3.
Figure 3.
Time trends of EMR use stratified by region. Rate of increase with 95% CI differ by region (p<0.001).
Figure 4.
Figure 4.
30-day adverse event rates after EMR versus simple polypectomies.
See this image and copyright information in PMC

Comment in

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