Sanjiv Mahadeva1, Bjorn J Rembacken. 1. Division of Gastroenterology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. sanjiv@ummc.edu.my
Abstract
BACKGROUND: Standard polypectomy techniques may be contributing to ineffective eradication of colonic superficial neoplasia, an increasing number of which are nonpolypoid. We aimed to demonstrate the practicality and efficacy of the "inject and cut" endoscopic mucosal resection (EMR) technique in routine clinical practice. METHODS: Colonic EMRs performed for polypoid and nonpolypoid lesions at a tertiary institution were prospectively collected and analyzed for efficacy, and short and long-term complications. RESULTS: 224 colonic neoplasms (143 flat, 65 sessile and 16 subpedunculated) were excised by the standard inject-and-cut method, with standard accessories. The median size of all lesions was 10 mm (range 2-50 mm) and 110 (49.2%) lesions were located in the proximal colon. Histological completeness of resection was achieved in 87% of cases. Of the lesions 77.2% were dysplastic, with 5 cases of carcinoma in situ and 18 severely dysplastic adenomas. Complications included bleeding in five cases (2.2 %) and a single case of perforation (0.4%). All complications were managed endoscopically. Median follow up at 24 +/- 16 months (range 12-84 months) revealed a 7.2% local recurrence rate, all of which were subsequently eradicated by repeat EMR. CONCLUSIONS: Standard inject-and-cut colonic EMR is practical and effective in the eradication of superficial colonic neoplasia.
BACKGROUND: Standard polypectomy techniques may be contributing to ineffective eradication of colonic superficial neoplasia, an increasing number of which are nonpolypoid. We aimed to demonstrate the practicality and efficacy of the "inject and cut" endoscopic mucosal resection (EMR) technique in routine clinical practice. METHODS: Colonic EMRs performed for polypoid and nonpolypoid lesions at a tertiary institution were prospectively collected and analyzed for efficacy, and short and long-term complications. RESULTS: 224 colonic neoplasms (143 flat, 65 sessile and 16 subpedunculated) were excised by the standard inject-and-cut method, with standard accessories. The median size of all lesions was 10 mm (range 2-50 mm) and 110 (49.2%) lesions were located in the proximal colon. Histological completeness of resection was achieved in 87% of cases. Of the lesions 77.2% were dysplastic, with 5 cases of carcinoma in situ and 18 severely dysplastic adenomas. Complications included bleeding in five cases (2.2 %) and a single case of perforation (0.4%). All complications were managed endoscopically. Median follow up at 24 +/- 16 months (range 12-84 months) revealed a 7.2% local recurrence rate, all of which were subsequently eradicated by repeat EMR. CONCLUSIONS: Standard inject-and-cut colonic EMR is practical and effective in the eradication of superficial colonic neoplasia.
Authors: Jason A Dominitz; Glenn M Eisen; Todd H Baron; Jay L Goldstein; William K Hirota; Brian C Jacobson; John F Johanson; Jonathan A Leighton; J Shawn Mallery; Hareth M Raddawi; John J Vargo; J Patrick Waring; Robert D Fanelli; Jo Wheeler-Harbough; Douglas O Faigel Journal: Gastrointest Endosc Date: 2003-04 Impact factor: 9.427
Authors: Nuzhat A Ahmad; Michael L Kochman; William B Long; Emma E Furth; Gregory G Ginsberg Journal: Gastrointest Endosc Date: 2002-03 Impact factor: 9.427
Authors: S J Winawer; A G Zauber; M N Ho; M J O'Brien; L S Gottlieb; S S Sternberg; J D Waye; M Schapiro; J H Bond; J F Panish Journal: N Engl J Med Date: 1993-12-30 Impact factor: 91.245