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CC BY-NC-ND 4.0 · Endosc Int Open 2023; 11(01): E82-E89
DOI: 10.1055/a-1984-6753
Original article

Need for adjunctive removal techniques for endoscopic mucosal resection of large non-pedunculated colonic polyps is predictive of recurrence

Suqing Li
1   Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Canada
,
Jeffrey Mosko
2   Division of Gastroenterology, Department of Medicine, The Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael’s Hospital, Toronto, Canada
,
Gary May
2   Division of Gastroenterology, Department of Medicine, The Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael’s Hospital, Toronto, Canada
,
Gabor Kandel
2   Division of Gastroenterology, Department of Medicine, The Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael’s Hospital, Toronto, Canada
,
Paul Kortan
2   Division of Gastroenterology, Department of Medicine, The Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael’s Hospital, Toronto, Canada
,
Norman Marcon
2   Division of Gastroenterology, Department of Medicine, The Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael’s Hospital, Toronto, Canada
,
Christopher Teshima
2   Division of Gastroenterology, Department of Medicine, The Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael’s Hospital, Toronto, Canada
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Abstract

Background and study aims Endoscopic mucosal resection (EMR) allows for safe and effective removal of large non-pedunculated colon polyps, but recurrence remains a significant concern. Risk factors for recurrence have previously been reported, however, the significance of these factors have varied and has uncertain applicability with recent advances in EMR techniques. We aimed to evaluate rates and risk factors for recurrence in recent years from a major Canadian referral center.

Patients and methods Consecutive patients between April 1, 2017 and March 1, 2019 who underwent piecemeal EMR were retrospectively identified. Patients with non-pedunculated colorectal polyps ≥ 2 cm removed by piecemeal EMR with available follow-up data were included.

Results Five hundred and seventeen patients were reviewed, with 265 patients satisfying inclusion criteria. The median age was 67 years (IQR 14); 48 % were female. 15 % had a recurrence on follow-up endoscopy. Adjunctive removal techniques were utilized in 31 % of patients, 95 % of which was hot avulsion. The use of adjunctive removal techniques (OR 2.87, P = 0.004) and male gender (OR 3.31, P = 0.003) was significantly predictive of recurrence on multivariate analysis. Receiver operating curve characteristics demonstrated good performance of these factors in predicting recurrence (area under the curve = 0.70).

Conclusions The use of adjunctive removal techniques, particularly hot avulsion and male gender are predictive of recurrence after piecemeal EMR of large non-pedunculated colorectal polyps. Male patients and those who require hot avulsion may be considered high risk for recurrence and warrant closer follow-up.

Supplementary material



Publication History

Received: 14 March 2022

Accepted after revision: 29 September 2022

Accepted Manuscript online:
22 November 2022

Article published online:
19 January 2023

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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