Appropriate Treatment For Non-Pedunculated Colorectal Polyps > 20 MM According To Western And Eastern Approach: Conditional Inference-Tree From A Prospective Multicenter Cohort

Aims To determine algorithms for choosing the suitable treatment in non-pedunculated colorectal lesions ≥20 mm assessed by Western endoscopists with NBI and without magnification.​​​​

Methods Observational prospective multicenter study conducted at 17 academic and community hospitals by 58 endoscopists. Unbiased conditional inference trees (CTREE) were fitted to analyze the association between the appropriate treatment based on the histology (surgery, en bloc resection or piecemeal EMR) based on the endoscopic characteristics of the lesions.

Results 542 lesions from 517 patients were included in the analysis. The most important lesion characteristic for choosing piecemeal EMR was the absence of ulceration (p<0.001). In lesions with this feature, the probability of submucosal (sm) invasion was 75 %. In lesions without ulceration, the presence of non-granular lateral spreading lesions pseudodepressed type LST-NG (IIa+IIc) also changed the probability of sm invasion to 36 % (p<0.001). If none of these 2 features were observed, sessile morphology also changed the probability of sm invasion to 13.7 % (p<0.001). However, if none of these 3 features were present, the probability of sm invasion was 3.8 % (p<0.001). No definitive algorithm was found to choose en bloc resection or surgery.

Conclusions In lesions ≥20 mm, piecemeal EMR is the adequate treatment in the absence of ulceration, LST-NG pseudodepressed or sessile type. Morphology, location, gross morphological malignant features and the NICE classification are not sufficient to accurately predict sm invasion if any of the previous characteristics are present. In this case, further diagnosis techniques like magnification or diagnostic +/- therapeutic ESD should be considered.

Citation: da Costa-Seixas J, López-Cerón M, Arnau A et al. OP214 APPROPRIATE TREATMENT FOR NON-PEDUNCULATED COLORECTAL POLYPS > 20 MM ACCORDING TO WESTERN AND EASTERN APPROACH: CONDITIONAL INFERENCE-TREE FROM A PROSPECTIVE MULTICENTER COHORT. Endoscopy 2021; 53: S88.

Publication History

Article published online:
19 March 2021