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Showing content from https://doi.org/10.1136/gutjnl-2015-310249 below:

Endoscopic mucosal resection for large serrated lesions in comparison with adenomas: a prospective multicentre study of 2000 lesions

1. Maria Pellise1,
2. Nicholas G Burgess1,2,
3. Nicholas Tutticci1,
4. Luke F Hourigan3,4,
5. Simon A Zanati5,6,
6. Gregor J Brown5,7,
7. Rajvinder Singh8,
8. Stephen J Williams1,
9. Spiro C Raftopoulos9,
10. Donald Ormonde9,
11. Alan Moss6,
12. Karen Byth10,11,
13. Heok P'Ng12,
14. Hema Mahajan12,
15. Duncan McLeod12,
16. Michael J Bourke1,2

1. ¹Departments of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
2. ²Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
3. ³Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
4. ⁴Department of Gastroenterology and Hepatology, Greenslopes Private Hospital, Brisbane, Queensland, Australia
5. ⁵Department of Gastroenterology and Hepatology, The Alfred Hospital, Melbourne, Victoria, Australia
6. ⁶Department of Gastroenterology and Hepatology, Western Hospital, Melbourne, Victoria, Australia
7. ⁷Department of Gastroenterology and Hepatology, Epworth Hospital, Melbourne, Victoria, Australia
8. ⁸Department of Gastroenterology and Hepatology, Lyell McEwin Hospital, Adelaide, South Australia, Australia
9. ⁹Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
10. ¹⁰NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia.
11. ¹¹Research and Education Network, Westmead Hospital, Sydney, New South Wales, Australia
12. ¹²Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, New South Wales, Australia

1. Correspondence to Professor Michael J Bourke, Department of Gastroenterology and Hepatology, Westmead Hospital, c/- Suite 106a, 151-155 Hawkesbury Road, Westmead, Sydney, NSW 2143, Australia; michael{at}citywestgastro.com.au

Objective Endoscopic mucosal resection (EMR) is effective for large laterally spreading flat and sessile lesions (LSLs). Sessile serrated adenomas/polyps (SSA/Ps) are linked to the relative failure of colonoscopy to prevent proximal colorectal cancer. We aimed to examine the technical success, adverse events and recurrence following EMR for large SSA/Ps in comparison with large conventional adenomas.

Design Over 74 months till August 2014, prospective multicentre data of LSLs ≥20 mm were analysed. A standardised dye-based conventional EMR technique followed by scheduled surveillance colonoscopy was used.

Results From a total of 2000 lesions, 323 SSA/Ps in 246 patients and 1527 adenomas in 1425 patients were included for analysis. Technical success for EMR was superior in SSA/Ps compared with adenomas (99.1% vs 94.5%, p<0.001). Significant bleeding and perforation were similar in both cohorts. The cumulative recurrence rates for adenomas after 6, 12, 18 and 24 months were 16.1%, 20.4%, 23.4% and 28.4%, respectively. For SSA/Ps, they were 6.3% at 6 months and 7.0% from 12 months onwards (p<0.001). Following multivariable adjustment, the HR of recurrence for adenomas versus SSA/Ps was 1.7 (95% CI 0.9 to 3.0, p=0.097). Subgroup analysis by lesion size revealed an eightfold increased risk of recurrence for 20–25 mm adenomas versus SSA/Ps, but no significantly different risk between lesion types in larger lesion groups.

Conclusion Recurrence after EMR of 20–25 mm LSLs is significantly less frequent in SSA/Ps compared with adenomatous lesions. SSA/Ps can be more effectively removed than adenomatous LSLs with equivalent safety. Ensuring complete initial resection is imperative for avoiding recurrence.

Trial registration number ClinicalTrials.gov NCT01368289.

• COLONOSCOPY
• COLORECTAL ADENOMAS
• COLONIC POLYPS
• COLORECTAL CANCER
• ENDOSCOPIC PROCEDURES

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