Hyun Gun Kim1, Nirav Thosani2, Subhas Banerjee2, Ann Chen2, Shai Friedland3. 1. Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea. 2. Department of Gastroenterology, Stanford University School of Medicine, Stanford, California, USA. 3. Department of Gastroenterology, Stanford University School of Medicine, Stanford, California, USA; VA Palo Alto Health Care System, Palo Alto, California, USA.
Abstract
BACKGROUND: Endoscopic manipulations, including biopsy sampling, tattoo application on the lesion itself, and sampling of the lesion with a polypectomy snare, are frequently performed on large nonpedunculated colorectal lesions ≥ 20 mm (LNCL) before referral for endoscopic resection. OBJECTIVE: To assess the effect of prior manipulations on the technical difficulty and recurrence rates of subsequent endoscopic treatment. DESIGN: Retrospective study. SETTING: Two referral centers. PATIENTS: Patients with LNCL referred for endoscopic resection. INTERVENTIONS: Endoscopic resection. MAIN OUTCOME MEASUREMENT: En-bloc resection rate, rate of successful complete endoscopic resection without the need for ablation of visible residual, recurrence rate on follow-up, independent predictive factors for en-bloc resection, complete resection without ablation of visible residual, and recurrence. RESULTS: A total of 132 lesions was analyzed: 46 lesions without any prior manipulation, 44 with prior biopsy sampling only, and 42 with prior advanced manipulation including tattoo and/or snare sampling. The en-bloc resection rate was 34.8% for nonmanipulated lesions, 15.9% for lesions with prior biopsy sampling, and 4.8% for lesions with prior advanced manipulation (P = .001). Complete endoscopic resection without the need for ablation of visible residual was performed in 93.5% of nonmanipulated lesions, 68.2% of lesions with prior biopsy sampling, and 50% of lesions with prior advanced manipulation (P < .001). Recurrence rates were 7.7%, 40.7%, and 53.8% in the 3 groups (P = .001). In multivariate analysis, prior biopsy sampling was an independent predictor for inability to perform complete resection without ablation of visible residual (odds ratio .24, P < .05) and for recurrence (odds ratio 11.5, P = .004) compared with nonmanipulated lesions. Prior advanced manipulation was an independent predictor for inability to perform en-bloc resection (odds ratio .024, P = .001), for inability to perform complete resection without ablation of visible residual (odds ratio .081, P < .001), and for recurrence (odds ratio 18.8, P = .001). LIMITATIONS: Retrospective study. CONCLUSIONS: Prior biopsy sampling and advanced manipulation have significant deleterious effects on endoscopic treatment of LNCL. Published by Elsevier Inc.
BACKGROUND: Endoscopic manipulations, including biopsy sampling, tattoo application on the lesion itself, and sampling of the lesion with a polypectomy snare, are frequently performed on large nonpedunculated colorectal lesions ≥ 20 mm (LNCL) before referral for endoscopic resection. OBJECTIVE: To assess the effect of prior manipulations on the technical difficulty and recurrence rates of subsequent endoscopic treatment. DESIGN: Retrospective study. SETTING: Two referral centers. PATIENTS: Patients with LNCL referred for endoscopic resection. INTERVENTIONS: Endoscopic resection. MAIN OUTCOME MEASUREMENT: En-bloc resection rate, rate of successful complete endoscopic resection without the need for ablation of visible residual, recurrence rate on follow-up, independent predictive factors for en-bloc resection, complete resection without ablation of visible residual, and recurrence. RESULTS: A total of 132 lesions was analyzed: 46 lesions without any prior manipulation, 44 with prior biopsy sampling only, and 42 with prior advanced manipulation including tattoo and/or snare sampling. The en-bloc resection rate was 34.8% for nonmanipulated lesions, 15.9% for lesions with prior biopsy sampling, and 4.8% for lesions with prior advanced manipulation (P = .001). Complete endoscopic resection without the need for ablation of visible residual was performed in 93.5% of nonmanipulated lesions, 68.2% of lesions with prior biopsy sampling, and 50% of lesions with prior advanced manipulation (P < .001). Recurrence rates were 7.7%, 40.7%, and 53.8% in the 3 groups (P = .001). In multivariate analysis, prior biopsy sampling was an independent predictor for inability to perform complete resection without ablation of visible residual (odds ratio .24, P < .05) and for recurrence (odds ratio 11.5, P = .004) compared with nonmanipulated lesions. Prior advanced manipulation was an independent predictor for inability to perform en-bloc resection (odds ratio .024, P = .001), for inability to perform complete resection without ablation of visible residual (odds ratio .081, P < .001), and for recurrence (odds ratio 18.8, P = .001). LIMITATIONS: Retrospective study. CONCLUSIONS: Prior biopsy sampling and advanced manipulation have significant deleterious effects on endoscopic treatment of LNCL. Published by Elsevier Inc.
Authors: Neal Mehta; Ashraf Abushahin; Meena Sadaps; Mohammad Alomari; John Vargo; Deepa Patil; Rocio Lopez; Matthew Kalady; Conor P Delaney; Emre Gorgun; James Church; Yutaka Saito; Carol A Burke; Amit Bhatt Journal: Surg Endosc Date: 2020-05-29 Impact factor: 4.584
Authors: Peter V Draganov; Hiroyuki Aihara; Michael S Karasik; Saowanee Ngamruengphong; Abdul Aziz Aadam; Mohamed O Othman; Neil Sharma; Ian S Grimm; Alaa Rostom; B Joseph Elmunzer; Salmaan A Jawaid; Donevan Westerveld; Yaseen B Perbtani; Brenda J Hoffman; Alexander Schlachterman; Amanda Siegel; Roxana M Coman; Andrew Y Wang; Dennis Yang Journal: Gastroenterology Date: 2021-02-19 Impact factor: 22.682