Anonymous User
Login / Registration

Gastroenterologie
a hepatologie

Gastroenterology and Hepatology

Gastroent Hepatol 2017; 71(5): 394–400. doi:10.14735/amgh2017394.

Risk factors for local residual neoplasia after endoscopic mucosal resection

Nagyija Brogyuk1, Tomáš Grega2, Michal Voška1, Ondřej Ngo3,4, Ondřej Májek5, Ladislav Dušek3,5, Miroslav Zavoral1, Štěpán Suchánek1

+ Affiliation

Summary

Introduction: Endoscopic mucosal resection (EMR) is considered an effective endoscopic treatment of sessile polyps and non-polypoid colorectal neoplasia. A limitation of this technique is the risk of incomplete endoscopic resection, which can lead to local residual neoplasia development. Aim: Identification of the risk factors associated with local residual neoplasia (LRN) onset. Methods: Retrospective analysis was performed on colorectal neoplasia EMRs in one high-volume tertiary-referral endoscopic center in 2013–2015. Individuals with at least one follow-up colonoscopy after the initial EMR were included. LRN was defined as the histopathological presence of neoplastic tissue at the post-EMR site. Univariate and multivariate analysis of factors associated with LRN were performed. Results: 280 EMRs of sessile polyps and non-polypoid colorectal neoplasia (size ≥ 10 mm) including laterally spreading tumors (LST) were analyzed and surveillance endoscopy was carried out on 186 lesions (66.4% of all EMRs) in 163 patients (66.3% male; mean age 67 years). The mean follow-up interval was 7.8 months. LRN was verified in 33 lesions (17.7%) resected by EMR. Single variate analysis showed evidence of an increased risk of residual neoplasia for lesions ≥ 20 mm (p = 0.006), LST with granular type (p = 0.002), villous component of adenomas with low grade dysplasia (p < 0.001), and with high grade dysplasia (p = 0.005), and piece meal EMR (p = 0.006). In multivariate analysis, there were no statistically significant factors associated with LRN. Conclusion: The risk factors for local residual neoplasia include lesion size ≥ 20 mm, villous component of adenomas, piece meal EMR technique, and LST lesions of the granular type. In these cases, earlier endoscopic post-EMR surveillance or alternative endoscopic or surgical techniques should be considered.

Keywords

endoscopic mucosal resection, laterally spreading tumor, local residual neoplasia, risk factors

To read this article in full, please register for free on this website.

Benefits for subscribers

Benefits for logged users

Literature

1. Zavoral M, Vojtěchová G, Májek O et al. Populační screening kolorektálního karcinomu v České republice. Čas Lék Čes 2016; 155: 7–12.
2. Brenner H, Stock C, Hoffmeister M et al. Effect of screening sigmoidoscopy and screening colonoscopy on colorectal cancer incidence and mortality: systematic review and meta-analysis of randomised controlled trials and observational studies. BMJ 2014; 348: g2467. doi: 10.1136/bmj.g2467.
3. Løberg M, Kalager M, Holme Ø et al. Long-term colorectal-cancer mortality after adenoma removal. N Engl J Med 2014; 371 (9): 799–807. doi: 10.1056/ NEJMoa1315870.
4. Zauber AG, Winawer SJ, O’Brien MJ et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 2012; 366 (8): 687–696. doi: 10.1056/NEJMoa1100370.
5. Ferlitsch M, Moss A, Hassan C et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE). Endoscopy 2017; 49 (3): 270–297. doi: 10.1055/s-0043-102569.
6. Urban O, Kijonkova B, Kajzrlikova IM et al. Local residual neoplasia after endoscopic treatement of laterally spreading tumors during 15 months of follow-up. Eur J Gastroenterol Hepatol 2013; 25 (6): 733–738. doi: 10.1097/MEG.0b013e32835eda96.
7. Belderbos GE, Leenders M, Moons LM et al. Local recurrence after endoscop-ic mucosal resection of nonpedunculated colorectal lesions: systematic review and meta-analysis. Endoscopy 2014, 46: 388–400. doi: 10.1055/s-0034-1364970.
8. Khashab M, Eid E, Rusche M et al. Incidence and predictors of “late” recurrences after endoscopic piecemeal resection of large sessile adenomas. Gastrointest Endosc 2009; 70 (2): 344–349. doi: 10.1016/j.gie.2008.10.037.
9. Luigiano C, Consolo P, Scaffidi MG et al. Endoscopic mucosal resection for large and giant sessile and flat colorectal polyps: a single-center experience with long-term follow-up. Endoscopy 2009; 41 (10): 829–835. doi: 10.1055/s-0029-1215091.
10. Ferrara F, Luigiano C, Ghersi S et al. Efficacy, safety and outcomes of ‘inject and cut’ endoscopic mucosal resection for large sessile and flat colorectal polyps. Digestion 2010; 82 (4): 213–220. doi: 10.1159/000284397.
11. Ah Soune P, Ménard C, Salah E et al. Large endoscopic mucosal resection for colorectal tumors exceeding 4 cm. World J Gastroenterol 2010; 16 (5): 588–595.
12. Buchner AM, Guarner-Argente C, Ginsberg GG et al. Outcomes of EMR of defiant colorectal lesions directed to an endoscopy referral center. Gastrointest Endosc 2012; 76 (2): 255–263. doi: 10.1016/j.gie.2012.02.060.
13. Sakamoto T, Matsuda T, Otake Y et al. Predictive factors of local recurrence after endoscopic piecemeal mucosal resection. J Gastroenterol 2012; 47 (6): 635–640. doi: 10.1007/s00535-011-0524-5.
14. Woodward TA, Heckman MG, Cleve-land P et al. Predictors of complete endoscopic mucosal resection of flat and depressed gastrointestinal neoplasia of the colon. Am J Gastroenterol 2012; 107 (5): 650–654. doi: 10.1038/ajg.2011.473.
15. Carvalho R, Areia M, Brito D et al. Endoscopic mucosal resection of large colorectal polyps: prospective evaluation of recurrence and complications. Acta Gastroenterol Belg 2013; 76 (2): 225–230.
16. Maguire LH, Shellito PC. Endoscopic piecemeal resection of large colorectal polyps with long-term followup. Surg Endosc 2014; 28 (9): 2641–2648. doi: 10.1007/ s00464-014-3516-8.
17. Moss A, Williams SJ, Hourigan LF et al. Long-term adenoma recurrence following widefield endoscopic mucosal resection (WFEMR) for advanced colonic mucosal neoplasia is infrequent: results and risk factors in 1000 cases from the Australian Colonic EMR (ACE) study. Gut 2015; 64 (1): 57–65. doi: 10.1136/gutjnl-2013-305516.
18. Oka S, Tanaka S, Saito Y et al. Local recurrence after endoscopic resection for large colorectal neoplasia: a multicenter prospective study in Japan. Am J Gastroenterol 2015; 110 (5): 697–707. doi: 10.1038/ ajg.2015.96.
19. Davila RE, Rajan E, Baron TH et al. ASGE guideline: colorectal cancer screening and surveillance. Gastrointest Endosc 2006; 63 (4): 546–557. doi: 10.1016/j.gie.2006.02.002.
20. Hassan C, Quintero E, Dumonceau JM et al. Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline.  Endoscopy 2013; 45 (10): 842–851. doi: 10.1055/s-0033-1344548.
21. Pox C, Aretz S, Bischoff SC et al.  S3-guideline colorectal cancer version 1.0. Z Gastroenterol 2013; 51 (8): 753–854. doi: 10.1055/s-0033-1350264.
22. Tanaka S, Kashida H, Saito Y et al. JGES guidelines for colorectal endoscopic submucosal dissection/ endoscopic mucosal resection. Dig Endosc 2015; 27 (4): 417–434. doi: 10.1111/den.12456.
23. Urban O, Pipek B, Mikoviny Kajzrlikova I et al. The efficacy of treatment of local residual neopasia under standardized conditions. Vnitř Lék 2016; 62 (5): 365–369.
24. The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc 2003; 58 (6 Suppl): S3–43.
25. Ferlitsch M, Moss A, Hassan C et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE). Endoscopy 2017; 49 (03): 270–297. doi: 10.1055/ s-0043-102569.
26. Urban O. Endoskopická léčba časných kolorektálních neoplazií. Onkologie 2013; 7 (4): 183–187.
27. Moss A, Bourke MJ, Williams SJ et al. Endoscopic mucosal resection outcomes and prediction of submucosal cancer from advanced colonic mucosal neoplasia. Gastroenterology 2011; 140 (7): 1909–1918. doi: 10.1053/j.gastro.2011.02.062.
28. Hotta K, Fujii T, Saito Y et al. Local recurrence after endoscopic resection of colorectal tumors. Int J Colorectal Dis 2009; 24 (2): 225–230. doi: 10.1007/s00384-008-0596-8.
29. Pohl H, Srivastava A, Bensen SP et al. Incomplete polyp resection during colonoscopy – results of the complete adenoma resection (CARE) study. Gastroenterology 2013; 144 (1): 74–80. doi: 10.1053/j.gastro.2012.09.043.
30. Briedigkeit A, Sultanie O, Sido B et al. Endoscopic mucosal resection of colorectal adenomas > 20 mm: risk factors for recurrence. World J Gastrointest Endosc 2016; 8 (5): 276–281. doi: 10.4253/wjge.v8.i5.276.
31. Lim TR, Mahesh V, Singh S et al. Endoscopic mucosal resection of colorectal polyps in typical UK hospitals. World J Gastroenterol 2010; 16 (42): 5324–5328.
32. Luigiano C, Consolo P, Scaffidi MG et al. Endoscopic mucosal resection for large and giant sessile and flat colorectal polyps: a single-center experience with long-term follow-up. Endoscopy 2009; 41 (10): 829–835. doi: 10.1055/s-0029-1215091.
33. Hassan C, Repici A, Sharma P et al.  Efficacy and safety of endoscopic resection of large colorectal polyps: a systematic review and meta-analysis. Gut 2016; 65 (5): 806–820. doi: 10.1136/gutjnl-2014-308481.
34. Lim TR, Mahesh V, Singh S et al. Endoscopic mucosal resection of colorectal polyps in typical UK hospitals. World J Gastroenterol 2010; 16 (42): 5324–5328.
35. Mannath J, Subramanian V, Singh R et al. Polyp recurrence after endoscopic mucosal resection of sessile and flat colonic adenomas. Dig Dis Sci 2011; 56 (8): 2389–2395. doi: 10.1007/s10620-011-1609-y.
36. Cipolletta L, Rotondano G, Bianco MA et al. Endoscopic resection for superficial colorectal neoplasia in Italy: a prospective multicentre study. Dig Liver Dis 2014; 46 (2): 146–151. doi: 10.1016/j.dld.2013.09. 019.

Kreditovaný autodidaktický test