Rm Barendse1, Gd Musters1, P Fockens2, Wa Bemelman1, Ej de Graaf3, Fj van den Broek2, K van der Linde4, Mp Schwartz5, Mh Houben6, Aw van Milligen de Wit7, Bj Witteman8, R Winograd9, E Dekker2. 1. Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands. 2. Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands. 3. Department of Surgery, Ijsselland Hospital, Capelle a/d Ijssel, the Netherlands. 4. Department of Gastroenterology and Hepatology, Medical Center Leeuwarden, the Netherlands. 5. Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, the Netherlands. 6. Department of Gastroenterology and Hepatology, Haga Hospital, 's Gravenhage, the Netherlands. 7. Department of Gastroenterology and Hepatology, Amphia Hospital, Breda, the Netherlands. 8. Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, the Netherlands. 9. Department of Gastroenterology and Hepatology, Ijsselland Hospital, Capelle a/d Ijssel; the Netherlands.
Abstract
BACKGROUND AND OBJECTIVE: Endoscopic mucosal resection (EMR) of large rectal adenomas is largely being centralized. We assessed the safety and effectiveness of EMR in the rectum in a collaboration of 15 Dutch hospitals. METHODS: Prospective, observational study of patients with rectal adenomas >3 cm, resected by piecemeal EMR. Endoscopic treatment of adenoma remnants at 3 months was considered part of the intervention strategy. Outcomes included recurrence after 6, 12 and 24 months and morbidity. RESULTS: Sixty-four patients (50% male, age 69 ± 11, 96% ASA 1/2) presented with 65 adenomas (diameter 46 ± 17 mm, distance ab ano 4.5 cm (IQR 1-8), 6% recurrent lesion). Sixty-two procedures (97%) were technically successful. Histopathology revealed invasive carcinoma in three patients (5%), who were excluded from effectiveness analyses. At 3 months' follow-up, 10 patients showed adenoma remnants. Recurrence was diagnosed in 16 patients during follow-up (recurrence rate 25%). Fifteen of 64 patients (23%) experienced 17 postprocedural complications. CONCLUSION: In a multicenter collaboration, EMR was feasible in 97% of patients. Recurrence and postprocedural morbidity rates were 25% and 23%. Our results demonstrate the outcomes of EMR in the absence of tertiary referral centers.
BACKGROUND AND OBJECTIVE: Endoscopic mucosal resection (EMR) of large rectal adenomas is largely being centralized. We assessed the safety and effectiveness of EMR in the rectum in a collaboration of 15 Dutch hospitals. METHODS: Prospective, observational study of patients with rectal adenomas >3 cm, resected by piecemeal EMR. Endoscopic treatment of adenoma remnants at 3 months was considered part of the intervention strategy. Outcomes included recurrence after 6, 12 and 24 months and morbidity. RESULTS: Sixty-four patients (50% male, age 69 ± 11, 96% ASA 1/2) presented with 65 adenomas (diameter 46 ± 17 mm, distance ab ano 4.5 cm (IQR 1-8), 6% recurrent lesion). Sixty-two procedures (97%) were technically successful. Histopathology revealed invasive carcinoma in three patients (5%), who were excluded from effectiveness analyses. At 3 months' follow-up, 10 patients showed adenoma remnants. Recurrence was diagnosed in 16 patients during follow-up (recurrence rate 25%). Fifteen of 64 patients (23%) experienced 17 postprocedural complications. CONCLUSION: In a multicenter collaboration, EMR was feasible in 97% of patients. Recurrence and postprocedural morbidity rates were 25% and 23%. Our results demonstrate the outcomes of EMR in the absence of tertiary referral centers.
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