Extended endoscopic mucosal resection does not reduce recurrence compared with standard endoscopic mucosal resection of large laterally spreading colorectal lesions.

Research paper by Farzan F FF Bahin, Maria M Pellise, Stephen J SJ Williams, Michael J MJ Bourke

Indexed on: 18 May '16Published on: 18 May '16Published in: Gastrointestinal Endoscopy


Effective interventions to prevent residual and/or recurrent adenoma (RRA) after endoscopic mucosal resection (EMR) of large sessile and laterally spreading colorectal lesions (LSL) are yet to be determined. RRA may occur due to inconspicuous adenoma at the EMR margin. We aimed to determine the efficacy and safety of extended EMR (X-EMR) compared with standard EMR (S-EMR).A single-center post-hoc analysis of LSL ≥20mm referred for treatment was performed. S-EMR was the standard sequential inject and resect method including a 1- to mm margin of normal mucosa around the lesion. With X-EMR at least a 5 mm margin of normal mucosa was excised. Patient and lesion characteristics and procedural outcomes were recorded. First surveillance colonoscopy (SC1) was scheduled for 4 months. The primary endpoint was RRA at SC1.Between January 2009 to May 2011, 471 lesions (mean size 37.9 mm) in 424 patients were resected by S-EMR and between January 2012 to December 2013, 448 lesions (mean size 39.1 mm) in 396 patients were resected by X-EMR. Resection was successful in 92.3% and 92.6% of referred lesions in the S-EMR and X-EMR groups, respectively (P = .978). X-EMR was independently associated with a higher risk of intraprocedural bleeding (IPB) (OR, 3.1; 95% CI, 2.0-5.0; P < .001) but not other adverse events. RRA was present in 39 out of 333 patients (11.7%) and 30 out of 296 patients (10.1%) in the S-EMR and X-EMR groups, respectively (P = .15). X-EMR was not related to recurrence (HR, 0.8; 95% CI, 0.5-1.3; P = .399).X-EMR does not reduce RRA and increases the risk of IPB compared with S-EMR. Alternative methods for the prevention of RRA are required.