Margin marking before colorectal endoscopic mucosal resection and its impact on neoplasia recurrence (with video) - 18/04/22
Abstract |
Background and Aims |
Ablation of resection margins after EMR of large nonpedunculated colorectal polyps decreases recurrence. Margin marking before EMR (EMR-MM) may represent an alternative method to achieve a healthy resection margin. We aimed to determine the efficacy of EMR-MM in reducing neoplasia recurrence.
Methods |
We conducted a single-center historical control study of EMR cases (EMR-MM vs conventional EMR) for nonpedunculated polyps ≥20 mm between 2016 and 2021. For EMR-MM, cautery marks were placed along the lateral margins of the polyp with the snare tip. EMR was then performed to include resection of the healthy mucosa containing the marks. We compared recurrence at surveillance colonoscopy after EMR-MM versus historical control subjects. Multivariable logistic regression was performed to identify factors associated with recurrence.
Results |
Two hundred ten patients with 210 polyps (median size, 30 mm; interquartile range: 25-40) underwent EMR-MM (n = 74) or conventional EMR (n = 136). Patient and lesion characteristics were similar between the groups. At a median follow-up of 6 months, the recurrence rate was lower with EMR-MM (6/74; 8%) compared with historical control subjects (39/136; 29%) (P < .001). EMR-MM was not associated with an increased rate of adverse events. On multivariable analysis, EMR-MM remained the strongest predictor of recurrence (odds ratio, .20; 95% confidence interval, .13-.64; P = .003) aside from polyp size (odds ratio, 2.81; 95% confidence interval, 1.35-6.01; P = .008).
Conclusions |
In this single-center historical control study, EMR-MM of large nonpedunculated colorectal polyps reduced the recurrence risk by 80% when compared with conventional EMR. This simple technique may provide an alternative to margin ablation.
Il testo completo di questo articolo è disponibile in PDF.Abbreviations : EMR-MM, ESD, IQR, OR, SC
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| DISCLOSURE: The following authors disclosed financial relationships: D. Yang: Consultant for Boston Scientific, Olympus, Lumendi, and Steris. P. V. Draganov: Consultant for Olympus, Boston Scientific, Cook Medical, Merit, Microtech, Steris, Lumendi, and Fujifilm. H. Pohl: Research grants from Steris and Cosmo/Aries Pharmaceuticals. All other authors disclosed no financial relationships. |
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| DIVERSITY, EQUITY, AND INCLUSION: We worked to ensure gender balance in the recruitment of human subjects. We worked to ensure ethnic or other types of diversity in the recruitment of human subjects. One or more of the authors of this paper self-identifies as an under-represented gender minority in science. One or more of the authors of this paper self-identifies as an under-represented ethnic minority in science. The author list of this paper includes contributors from the location where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. |
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| If you would like to chat with an author of this article, you may contact Dr Yang at dennisj.yang@gmail.com. |
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| See CME section, p. 1001. |
Vol 95 - N° 5
P. 956-965 - maggio 2022 Ritorno al numero
Articolo precedente
- When it comes to continuous measurement of colonoscopy quality, patient survival is mandatory
- Nastazja Dagny Pilonis, Michal F. Kaminski
- Connecting the dots to eliminate recurrence after endoscopic mucosal resection in the colon
- Hunter Wang, Michael J. Bourke
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