Amol Agarwal1, Sidyarth Garimall2, Caitlin Colling3, Nuzhat A Ahmad4, Michael L Kochman4, Gregory G Ginsberg4, Vinay Chandrasekhara5. 1. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 2. School of Medicine, University of Queensland, Brisbane, Queensland, Australia. 3. Department of Medicine, Massachusetts General Hospital, Boston, MA, USA. 4. Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 5. Division of Gastroenterology, Mayo School of Medicine, 200 First St. SW, Rochester, MN, 55905, USA. Chandrasekhara.Vinay@mayo.edu.
Abstract
PURPOSE: To investigate advanced neoplasia (AN) after endoscopic mucosal resection (EMR) of colonic laterally spreading lesions (LSLs). METHODS: A retrospective study of patients who underwent injection-assisted EMR of colonic LSLs ≥ 10 mm was performed. Primary outcome was overall rate of AN at initial surveillance colonoscopy. Secondary outcomes were the rates of residual AN (rAN) at the EMR site and metachronous AN (mAN), and analysis of risk factors for AN, including effect of surveillance guidance. RESULTS: Three hundred seventy-four patients underwent successful EMR for 388 LSLs. AN occurred in 66/374 (17.6%) patients on initial surveillance colonoscopy at median follow-up of 364.5 days. Two patients had both rAN and mAN, for a total of 68 instances of AN, including 30/374 (8.0%) cases of rAN and 38/374 (10.2%) cases of mAN. On multivariate analysis, use of piecemeal resection was associated with increased likelihood of residual AN (P = 0.003, OR 9.2, 95% CI 2.1-33.3). Twenty-nine out of thirty cases (96.7%) of rAN were successfully endoscopically managed at surveillance colonoscopy. CONCLUSIONS: AN occurred in 17.6% of all patients at initial surveillance colonoscopy at a median of 1 year after EMR. Roughly half of the instances of AN were metachronous lesions. Our data support a 1-year surveillance interval after EMR of LSLs ≥ 10 mm with careful inspection of the entire colon, not just the prior resection site.
PURPOSE: To investigate advanced neoplasia (AN) after endoscopic mucosal resection (EMR) of colonic laterally spreading lesions (LSLs). METHODS: A retrospective study of patients who underwent injection-assisted EMR of colonic LSLs ≥ 10 mm was performed. Primary outcome was overall rate of AN at initial surveillance colonoscopy. Secondary outcomes were the rates of residual AN (rAN) at the EMR site and metachronous AN (mAN), and analysis of risk factors for AN, including effect of surveillance guidance. RESULTS: Three hundred seventy-four patients underwent successful EMR for 388 LSLs. AN occurred in 66/374 (17.6%) patients on initial surveillance colonoscopy at median follow-up of 364.5 days. Two patients had both rAN and mAN, for a total of 68 instances of AN, including 30/374 (8.0%) cases of rAN and 38/374 (10.2%) cases of mAN. On multivariate analysis, use of piecemeal resection was associated with increased likelihood of residual AN (P = 0.003, OR 9.2, 95% CI 2.1-33.3). Twenty-nine out of thirty cases (96.7%) of rAN were successfully endoscopically managed at surveillance colonoscopy. CONCLUSIONS: AN occurred in 17.6% of all patients at initial surveillance colonoscopy at a median of 1 year after EMR. Roughly half of the instances of AN were metachronous lesions. Our data support a 1-year surveillance interval after EMR of LSLs ≥ 10 mm with careful inspection of the entire colon, not just the prior resection site.
Authors: Timothy A Woodward; Michael G Heckman; Patrick Cleveland; Silvio De Melo; Massimo Raimondo; Michael Wallace Journal: Am J Gastroenterol Date: 2012-05 Impact factor: 10.864
Authors: René Lambert; Shin Ei Kudo; Michael Vieth; John I Allen; Hiroaki Fujii; Takahiro Fujii; Hiroshi Kashida; Takahisa Matsuda; Masaki Mori; Hiroshi Saito; Tadakazu Shimoda; Shinji Tanaka; Hidenobu Watanabe; Joseph J Sung; Andrew D Feld; John M Inadomi; Michael J O'Brien; David A Lieberman; David F Ransohoff; Roy M Soetikno; Ann Zauber; Claudio Rolim Teixeira; Jean Francois Rey; Edgar Jaramillo; Carlos A Rubio; Andre Van Gossum; Michael Jung; Jeremy R Jass; George Triadafilopoulos Journal: Gastrointest Endosc Date: 2009-10-31 Impact factor: 9.427