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Endoscopic mucosal resection of colorectal polyps: results, adverse events and two-year outcome

Journal Volume 85 - 2022
Issue Fasc.1 - Original articles
Author(s) I. Chaoui 1, I. Demedts 2, P. Roelandt 2, H. Willekens 2, R. Bisschops 2
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Full Article
PAGES 47-55
(1) Faculty of Medicine, Catholic University Leuven, Leuven, Belgium
(2) Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium

Background and study aims: Endoscopic mucosal resection (EMR) is the first-line treatment for large sessile and flat colorectal polyps in Western centres, however recurrence after EMR continues to be a challenge. The aim of this study is to assess efficacy, safety and recurrence rate of EMR in a tertiary centre and to identify risk factors for recurrence at first surveillance endoscopy (SE1).

Patients and methods: We performed a retrospective study of 165 sessile and flat colorectal lesions ≥15 mm, treated by EMR between 2017-2019. We used multivariate logistic regression to identify independent risk factors for recurrence at SE1.

Results: EMR was performed for 165 colorectal polyps in 142 patients with technical success in 158 cases (95,2%). SE1 data for 117 of 135 eligible cases (86,7%) showed recurrent adenoma in 19 cases (16,2%) after a median time of 6,2 months (IQR 5-9,9). This was primarily treated endoscopically (78,9%). Independent risk factors for recurrence at SE1 were lesion size ≥40 mm (OR 4,03; p=0,018) and presence of high-grade dysplasia (HGD) (OR 3,89; p=0,034). Early adverse event occurred in 4 patients (2,4%), with 3 bleeding complications and one perforation. Twelve patients (7,2%) presented with delayed bleeding of which 3 required transfusion, with radiological intervention in one case. All other complications were managed either conservatively (n=8) or endoscopically (n=5).

Conclusions: EMR is a safe and effective treatment for large sessile and flat colorectal lesions with low recurrence rates. Lesion size ≥40 mm and presence of HGD were identified as risk factors for early recurrence, highlighting the importance of compliance to follow-up in these cases.

Keywords: EMR, polypectomy, colorectal, recurrence.

The authors declare that they have no conflict of interest.
© Acta Gastro-Enterologica Belgica.
PMID 35304993