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Incidence and risk factors of advanced neoplasia after endoscopic mucosal resection of colonic laterally spreading lesions

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International Journal of Colorectal Disease Aims and scope Submit manuscript

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.

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Author information

Authors and Affiliations

  1. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Amol Agarwal

  2. School of Medicine, University of Queensland, Brisbane, Queensland, Australia

    Sidyarth Garimall

  3. Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

    Caitlin Colling

  4. Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Nuzhat A. Ahmad, Michael L. Kochman & Gregory G. Ginsberg

  5. Division of Gastroenterology, Mayo School of Medicine, 200 First St. SW, Rochester, MN, 55905, USA

    Vinay Chandrasekhara

Authors
  1. Amol Agarwal
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  2. Sidyarth Garimall
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  3. Caitlin Colling
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  4. Nuzhat A. Ahmad
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  5. Michael L. Kochman
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  6. Gregory G. Ginsberg
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  7. Vinay Chandrasekhara
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Corresponding author

Correspondence to Vinay Chandrasekhara.

Ethics declarations

This retrospective observational study was approved by the Institutional Review Board at the University of Pennsylvania.

Conflict of interest

The author N.A. reports that spouse is employed with AstraZeneca and receives stock from Bristol-Myers Squibb. The author M.K. reports that his spouse is employed at Merck and he serves as a consultant with Boston Scientific and Dark Canyon Laboratory. The author G.G. serves as a consultant for Olympus Inc., Boston Scientific, Micro Interventional Devices, and Fractyl. The author V.C. serves as a consultant for Boston Scientific. All authors report no other conflicts of interest.

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Agarwal, A., Garimall, S., Colling, C. et al. Incidence and risk factors of advanced neoplasia after endoscopic mucosal resection of colonic laterally spreading lesions. Int J Colorectal Dis 33, 1333–1340 (2018). https://doi.org/10.1007/s00384-018-3075-x

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  • DOI: https://doi.org/10.1007/s00384-018-3075-x

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