TREATMENT OF RECURRENCES AFTER ENDOSCOPIC MUCOSAL RESECTION OF LARGE NON-PEDUNCULATED COLORECTAL POLYPS IN DAILY CLINICAL PRACTICE IS CHALLENGING

Aims Recurrence during surveillance after endoscopic mucosal resection (EMR) of non-pedunculated colorectal polyps≥20mm occurs in approximately 20% and endoscopic resection of recurrences is not always successful. We evaluated recurrence rates after colorectal EMR of polyps≥20 mm in daily clinical practice and the success of treatment of recurrent adenoma.

Methods In this retrospective multicentre cohort study, patients who underwent colorectal EMR for≥1 non-pedunculated colorectal polyps≥20 mm between 2014-2020 were included. Primary endpoints were adenoma recurrence during surveillance colonoscopy 6 months after EMR, resection technique of recurrences, and adenoma re-recurrences at 18 months after initial EMR. Secondary endpoints were predictive factors for (re-)recurrences.

Results EMR was performed for 1,284 large colorectal non-pedunculated polyps, and≥1 surveillance colonoscopy was performed after 1,013 EMR procedures. Recurrence during the first surveillance colonoscopy at 6 months after EMR was seen in 263 polyps (26.0%), but recurrence rates decreased during 2014-2019 from 33.8% to 4.3%. Treatment of choice for recurrence was EMR (49.4%), followed by cold snare resection (16.7%) or an avulsion technique (8.0%). A re-recurrence was seen in 33.5% (52/155) of polyps.

Conclusions Recurrence at 6-18 months after colorectal EMR of large non-pedunculated polyps in daily clinical practice is substantial but recurrence rates were found to decrease over time. Treatment of recurrences is challenging and was not successful in two-third of polyps, highlighting the need for further improvement.

Publication History

Article published online:
14 April 2022