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Clinical Trial
. 2025 Jun;57(6):620-628.
doi: 10.1055/a-2498-7114. Epub 2024 Dec 9.

Optical assessment of scars after endoscopic mucosal resection of large colorectal polyps in a multicenter, community hospital setting: is routine biopsy still necessary?

Lonne W T Meulen  1   2 , Roel M M Bogie  1   2 , Peter D Siersema  3 , Bjorn Winkens  4   5 , Marije S Vlug  6 , Frank H J Wolfhagen  7 , Martine A M C Baven-Pronk  8 , Michael P J A van der Voorn  9 , Matthijs P Schwartz  10 , Lauran Vogelaar  11 , Tom C J Seerden  12 , Wouter L Hazen  13 , Ruud W M Schrauwen  14 , Lorenza Alvarez Herrero  15 , Ramon-Michel Schreuder  16 , Annick B van Nunen  17 , Gijs J de Bruin  18 , Willem A Marsman  19 , Marc de Bièvre  20 , Robert Roomer  21 , Rogier J J de Ridder  1 , Maria Pellisé  22 , Michael J Bourke  23 , Ad A M Masclee  1 , Leon M G Moons  24 ; OPTICAL-STAR Working Group
Collaborators, Affiliations
Clinical Trial

Optical assessment of scars after endoscopic mucosal resection of large colorectal polyps in a multicenter, community hospital setting: is routine biopsy still necessary?

Lonne W T Meulen et al. Endoscopy. 2025 Jun.

Abstract

Background: Piecemeal endoscopic mucosal resection (EMR) of large (≥ 20 mm) nonpedunculated colorectal polyps (LNPCPs) is succeeded by a 6-month surveillance endoscopy to evaluate the post-EMR scar for recurrence. Data from expert centers suggest that routine tattoo placement and scar biopsies can be omitted, but data from community hospitals are lacking.

Methods: The agreement between optical assessment and histological confirmation by routine biopsies was evaluated in a post-hoc analysis of the STAR-LNPCP study (NTR7477), containing prospective data on 6-month post-EMR scar assessments in 30 Dutch community hospitals (October 2019 to May 2022). A standardized protocol was followed for documentation of optical characteristics, imaging, and biopsy of the post-EMR scar. RESULTS : In 1277 post-EMR scar assessments, identification of the scar was achieved in 1215/1277 (95 %). Tattoo placement did not influence scar identification. Scar biopsy was performed in 1050/1215 cases (86 %). Recurrences were seen in 200/1050 cases (19 %). There was good agreement between optical assessment of recurrence and histological confirmation (Cohen's kappa 0.78 [95 %CI 0.73-0.83]). The negative and positive predictive values were 98 % (95 %CI 97 %-99 %) and 74 % (95 %CI 68 %-80 %), respectively. A higher false-positive rate was seen after prior use of clips (11 % vs. 5 %; P = 0.02). Dedicated endoscopists identified the scar more often (96 % vs. 88 %; P < 0.001), and showed a lower optical recurrence miss rate (1 % vs. 3 %; P = 0.11) compared with nondedicated endoscopists. CONCLUSION : Based on this multicenter community hospital study, routine tattoo placement and scar biopsies of the post-EMR scar can be omitted. Assessment of post-EMR scars by dedicated endoscopists is advised.

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Conflict of interest statement

P. Siersema received grants or speaker’s fees from Pentax Japan, The E-Nose Company The Netherlands, Microtech China, Lucid Diagnostics USA, Magentiq Eye Israel, Norgine UK/The Netherlands, and Motus GI USA. M. Pellisé has received speaker’s fees from Norgine Iberia (2018–2023), Casen Recordati (2016 – 2019), Olympus (2018, 2022), Jansen (2018), Medtronic (2022), Fujifilm (2022); a consultancy fee GI Supply (2019), Fujifilm Europe (2022) and research funding from Fujifilm (2019–2021), Casen Recordati (2020); Ziuz (2021); 3-DMatrix (2021); her department has received loan material from Fujifilm (2017– ongoing), a consultancy service with Olympus (2022-ongoing); She is Board member of ESGE and AEG; and has received a fee from Thieme as an Endoscopy Co-Editor (2015–2021). She has shared actions of MiWendo. M. Bourke received research support for ethics-approved studies from Boston Scientific, Cook Medical, and Olympus Medical. A. Masclee received research grants from the Dutch Cancer Society (KWF) and the Dutch Organization for Health Research and Innovation (ZonMW). L. Moons acts as a consultant for Boston Scientific.The other authors disclose no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of patient inclusion and outcomes. LNPCP, large nonpedunculated colorectal polyp; EMR, endoscopic mucosal resection; eFTR, endoscopic full-thickness resection; ESD, endoscopic submucosal dissection.
See this image and copyright information in PMC

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