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Showing content from https://pubmed.ncbi.nlm.nih.gov/26786685/ below:

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

Observational Study

. 2017 Apr;66(4):644-653. doi: 10.1136/gutjnl-2015-310249. Epub 2016 Jan 19. Endoscopic mucosal resection for large serrated lesions in comparison with adenomas: a prospective multicentre study of 2000 lesions Nicholas G Burgess^{1 2}, Nicholas Tutticci¹, Luke F Hourigan^{3 4}, Simon A Zanati^{5 6}, Gregor J Brown^{5 7}, Rajvinder Singh⁸, Stephen J Williams¹, Spiro C Raftopoulos⁹, Donald Ormonde⁹, Alan Moss⁶, Karen Byth^{10 11}, Heok P'Ng¹², Hema Mahajan¹², Duncan McLeod¹², Michael J Bourke^{1 2}

Affiliations

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

PMID: 26786685
DOI: 10.1136/gutjnl-2015-310249

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Observational Study

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

Maria Pellise et al. Gut. 2017 Apr.

. 2017 Apr;66(4):644-653. doi: 10.1136/gutjnl-2015-310249. Epub 2016 Jan 19. Authors Maria Pellise¹, Nicholas G Burgess^{1 2}, Nicholas Tutticci¹, Luke F Hourigan^{3 4}, Simon A Zanati^{5 6}, Gregor J Brown^{5 7}, Rajvinder Singh⁸, Stephen J Williams¹, Spiro C Raftopoulos⁹, Donald Ormonde⁹, Alan Moss⁶, Karen Byth^{10 11}, Heok P'Ng¹², Hema Mahajan¹², Duncan McLeod¹², Michael J Bourke^{1 2} Affiliations

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

PMID: 26786685
DOI: 10.1136/gutjnl-2015-310249

Item in Clipboard

Abstract

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.

Keywords: COLONIC POLYPS; COLONOSCOPY; COLORECTAL ADENOMAS; COLORECTAL CANCER; ENDOSCOPIC PROCEDURES.

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