APPLICATION OF TWO SCORES TO PREDICT AND STRATIFY THE RISK OF RESIDUAL OR RECURRING ADENOMA AFTER PIECEMEAL EMR OF NON-PEDUNCULATED COLORECTAL POLYPS

Aims:

In 15 – 20% of colorectal EMR residual or recurring adenoma (RRA) is found at follow-up colonoscopy. The SERT score was recently developed to identify lesions most likely to recur. The SMSA score predicts difficulty in achieving endoscopic success after polypectomy. Our aim was to evaluate and compare prospectively the efficacy of these scores in identifying individually for each lesion the risk of RRA.

Methods:

Consecutive piecemeal EMR of non-pedunculated colorectal polyps ≥15 mm performed between Mar/2017-Mar/2018 were included. For each lesion, SMSA and SERT scores were calculated. Patients underwent follow-up colonoscopy within 3 – 6 months. The efficacy of the scores to predict RRA at follow-up colonoscopy was calculated using chi-square and AUROC tests.

Results:

158 piecemeal EMRs. Average lesion size: 25 mm (maximum:50). RRA found in 17 (10.8%). Of these, 13 (76.5%) were sucessfully endoscopically treated. The AUROC scores for the presence of relapse were: SERT: 0.730 (p = 0.002); SMSA: 0.723 (p = 0.003). The negative predictive value of SMSA 2 for RRA was 100% and of the SERT 0 was 94%. It was possible to to stratify the risk of RRA as low (SMSA 2 – 3 and SERT 0 – 1) and high (SMSA 4 and SERT 2 – 4).

Conclusions:

The SERT and SMSA scores are easy instruments to apply and effective to identify the individual risk of RRA for each lesion. The main value of these scores is the possibility to identify low-risk lesions, which could saffely be monitored later (> 6 months), with a reduction in costs and burden for the patient.