Eficacy and Safety of Endoscopic Mucosal Resection for Difficult Lesions: are Results From Leading Groups Reproducible by Non-Leading Groups?

Aims High Size Morphology Site Access (SMSA) score has been associated with more adverse events (AE), incomplete resection and recurrence by leading groups1. Our aim was to assess the efficacy and safety of EMR for lesions with high SMSA scores and comepare our results with those reported by a leading group.

Methods Observational, retrospective study. We included lesions with SMSA score ≥ 10 points (level ≥ 3) referred to an expert endoscopist because they were judged technically complex resections. Lesions and resection characteristics and AE were collected. Follow-up was performed within 6 months. We compared our results with the results of the Sidney group for levels SMSA 3 and 4¹.

Results We included 80 lesions. The median lesion size was 30 mm (range 20-70, IQR = 14). 91 % were Lateral Spreading Tumors, more frequently no granular flat elevated type (30 %). They were mostly located in the right colon (60 %), 39 % with difficult maneuverability. There were none incomplete resections. Overall, 85 % were piecemeal resections. 12.5 % of patients were receiving antithrombotic therapy and 25 % anticoagulants.Histological analysis revealed adenomatous lesions in 79 %, adenocarcinoma in 16 % and sessile serrated lesion in 5 %. Two patients had deep submucosal invasion.Post-EMR bleeding occurred in 7 %. Perforation requiring surgery appeared in 2.5 %, and post-polypectomy syndrome in <1 %.During follow-up (N = 49), 22 % of patients had recurrence, mostly treated endoscopically (91 %).Our efficacy was similar to that described by the Sidney group: recurrence 22 % vs. 9-23 % for SMSA 3 and 4, respectively. However, our rates of AE were slightly higher: bleeding 7 % vs. 4-7 % for SMSA 3 and 4, respectively; perforation (2 % vs. 0.4-0.6 % for SMSA 3 and 4, respectively).

Conclusions EMR for difficult lesions was as effective as described by leading groups in a non-leading group. However, the rates of AE, especially perforation, were slightly higher. 1. Sidhu. Endoscopy. 2018Jul;50(7):684-692.

Citation: Muñoz Gonzalez R, Escobar Ortiz J, Fernandez Velado E et al. eP222 EFICACY AND SAFETY OF ENDOSCOPIC MUCOSAL RESECTION FOR DIFFICULT LESIONS: ARE RESULTS FROM LEADING GROUPS REPRODUCIBLE BY NON-LEADING GROUPS? Endoscopy 2021; 53: S171.

Publication History

Article published online:
19 March 2021