Endoscopy 2019; 51(04): S152
DOI: 10.1055/s-0039-1681619
ESGE Days 2019 ePoster podium presentations
Friday, April 5, 2019 14:00 – 14:30: Colon: resection 3 ePoster Podium 2
Georg Thieme Verlag KG Stuttgart · New York

DEVELOPMENT OF A MODIFIED SMSA SCORING SYSTEM WITH IMPROVED ACCURACY IN THE PREDICTION OF COMPLICATIONS OF ENDOSCOPIC MUCOSAL RESECTION IN THE COLON

JC Silva
1   Gastroenterology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
,
J Rodrigues
1   Gastroenterology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
,
R Pinho
1   Gastroenterology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
,
M Sousa
1   Gastroenterology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
,
AC Gomes
1   Gastroenterology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
,
AP Silva
1   Gastroenterology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
,
J Carvalho
1   Gastroenterology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

The SMSA (size, morphology, site, access) scoring system allows stratification of the complexity of endoscopic mucosal resections (EMR). However, the influence of other lesion characteristics in EMR outcomes is widely recognized. The aim of this study was to develop a modified SMSA scoring system with complementary lesion characteristics and determine its accuracy in the prediction of complications of EMR.

Methods:

Consecutive colorectal, non-pedunculated lesions, ≥20 mm, referred to EMR between 2015 – 2016 were included. Lesions with previous resection attempts were excluded. The relation between SMSA and total complication rate (intra-procedure and post-EMR bleeding, intestinal perforation and post-polypectomy syndrome) was evaluated. Additional predictive characteristics of complications were determined and their incorporation into the SMSA evaluated.

Results:

225 lesions were selected, mean size 29.5 ± 13.0 mm, most of type 0-IIa (37.3%) or 0-Is (28.0%) Paris Classification, with granular surface (72.9%). Technical success of EMR was 94.2% (n = 212), with piecemeal (68.9%) or enbloc (31.1%) resection, and was related to the SMSA (p < 0.001). Total complication rate was 22.6%: intra-procedure bleeding = 15.1%; post-EMR bleeding = 6.1%; intestinal perforation = 0.9%; post-polypectomy syndrome = 0.9%. The area under the ROC curve of the SMSA for prediction of complications was 0.70 (95% CI 0.61 – 0.79, p < 0.001). On multivariate analysis, lesion component 0-IIb/0-IIc (OR = 2.4, 95% CI 1.1 – 6.5, p = 0.041) and non-granular/mixed surface type (OR = 2.6, 95% CI 1.2 – 5.9, p = 0.020) were associated with complications independently of the SMSA. The incorporation of the two characteristics into the SMSA (component 0-IIb/IIc = 2 points, non-granular/mixed surface = 3 points) had a significantly increased association with the total complication rate (area under the ROC curve = 0.79), by a difference of 0.087; p = 0.032 (DeLong et al. method).

Conclusions:

The incorporation of the Paris Classification (component 0-IIb or IIc) and the lesion surface type (granular or non-granular) into the SMSA scoring system increased its accuracy in the prediction of complications of EMR.