Impact of en bloc resection on long-term outcomes after endoscopic mucosal resection: a matched cohort study

Affiliations

¹ Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia; Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia; Department of Gastroenterology and Hepatology, University Hospital of Gent, Gent, Belgium.
² Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia; Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia.
³ Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia.
⁴ Department of Gastroenterology and Hepatology, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Gastroenterology and Hepatology, Epworth Hospital, Melbourne, Victoria, Australia.
⁵ Department of Gastroenterology and Hepatology, Greenslopes Private Hospital, Brisbane, Queensland, Australia; Gallipoli Medical Research Institute, School of Medicine, The University of Queensland, Greenslopes Private Hospital, Brisbane, Queensland, Australia.
⁶ Department of Gastroenterology and Hepatology, Footscray Hospital, Melbourne, Victoria, Australia; Department of Medicine, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.
⁷ Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
⁸ Department of Gastroenterology and Hepatology, Lyell McEwan Hospital, Adelaide, South Australia, Australia.
⁹ Department of Gastroenterology and Hepatology, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Gastroenterology and Hepatology, Footscray Hospital, Melbourne, Victoria, Australia.

PMID: 31887274
DOI: 10.1016/j.gie.2019.12.025

Clinical Trial

Impact of en bloc resection on long-term outcomes after endoscopic mucosal resection: a matched cohort study

David J Tate et al. Gastrointest Endosc. 2020 May.

. 2020 May;91(5):1155-1163.e1.

doi: 10.1016/j.gie.2019.12.025. Epub 2019 Dec 28.

Authors

Affiliations

¹ Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia; Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia; Department of Gastroenterology and Hepatology, University Hospital of Gent, Gent, Belgium.
² Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia; Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia.
³ Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia.
⁴ Department of Gastroenterology and Hepatology, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Gastroenterology and Hepatology, Epworth Hospital, Melbourne, Victoria, Australia.
⁵ Department of Gastroenterology and Hepatology, Greenslopes Private Hospital, Brisbane, Queensland, Australia; Gallipoli Medical Research Institute, School of Medicine, The University of Queensland, Greenslopes Private Hospital, Brisbane, Queensland, Australia.
⁶ Department of Gastroenterology and Hepatology, Footscray Hospital, Melbourne, Victoria, Australia; Department of Medicine, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.
⁷ Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
⁸ Department of Gastroenterology and Hepatology, Lyell McEwan Hospital, Adelaide, South Australia, Australia.
⁹ Department of Gastroenterology and Hepatology, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Gastroenterology and Hepatology, Footscray Hospital, Melbourne, Victoria, Australia.

PMID: 31887274
DOI: 10.1016/j.gie.2019.12.025

Abstract

Background and aims: Residual or recurrent adenoma (RRA) is the major limitation of piecemeal EMR (p-EMR) for large colonic laterally spreading lesions (LSLs) ≥20 mm. En bloc EMR (e-EMR) has been shown to achieve low rates of RRA but specific procedural and long-term outcomes are unknown. Our aim was to compare long-term outcomes of size-matched LSLs stratified by whether they were resected e-EMR or p-EMR.

Methods: Data from a prospective tertiary referral multicenter cohort of large LSLs referred for EMR over a 10-year period were analyzed. Outcomes were compared between sized-matched LSLs (20-25 mm) resected by p-EMR or e-EMR.

Results: Five hundred seventy LSLs met the inclusion criteria of which 259 (45.4%) were resected by e-EMR. The risk of major deep mural injury (DMI) was significantly higher in the e-EMR group (3.5% vs 1.0%, P = .05), whereas rates of other intraprocedural adverse events did not differ significantly. Five of 9 (56%) LSLs, with endoscopic features of submucosal invasion (SMI), resected by e-EMR were saved from surgery. RRA at first surveillance was lower in the e-EMR group (2.0% vs 5.7%, P = .04), but this difference was negated at subsequent surveillance. Rates of surgical referral were not significantly different between the groups at either surveillance interval.

Conclusion: When comparing e-EMR against p-EMR for lesions ≤25 mm in size of similar morphology in a large prospective multicenter cohort, e-EMR offered no additional advantage for predicted-benign LSLs. However, it was associated with an increased risk of major DMI. Thus, en bloc resection techniques should be reserved for lesions suspicious for invasive disease. (Clinical trial registration number: NCT01368289.).

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Comment in

Piecemeal resection of 20- to 25-mm colorectal polyps necessitates short-term surveillance colonoscopy to reduce local recurrence similar to en bloc removal.
Imai K, Hotta K, Ito S, Yamaguchi Y, Kishida Y, Ono H. Imai K, et al. Gastrointest Endosc. 2020 Dec;92(6):1276-1277. doi: 10.1016/j.gie.2020.06.074. Gastrointest Endosc. 2020. PMID: 33237001 No abstract available.
Response.
Sidhu M, Tate DJ, Bourke MJ. Sidhu M, et al. Gastrointest Endosc. 2020 Dec;92(6):1277-1278. doi: 10.1016/j.gie.2020.08.002. Gastrointest Endosc. 2020. PMID: 33237003 No abstract available.
Concerns of en bloc resection on long-term outcomes after EMR for colorectal laterally spreading tumor.
Wang L, Zhao L, Wang X. Wang L, et al. Gastrointest Endosc. 2021 Jan;93(1):280-281. doi: 10.1016/j.gie.2020.07.047. Gastrointest Endosc. 2021. PMID: 33353632 No abstract available.
Response.
Sidhu M, Tate DJ, Bourke MJ. Sidhu M, et al. Gastrointest Endosc. 2021 Jan;93(1):281-282. doi: 10.1016/j.gie.2020.09.009. Gastrointest Endosc. 2021. PMID: 33353633 No abstract available.

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Impact of en bloc resection on long-term outcomes after endoscopic mucosal resection: a matched cohort study

Affiliations

Impact of en bloc resection on long-term outcomes after endoscopic mucosal resection: a matched cohort study

Authors

Affiliations

Abstract

Comment in

Publication types

MeSH terms

Associated data

LinkOut - more resources

Full Text Sources

Medical

Research Materials

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