Endoscopy 2018; 50(07): 684-692
DOI: 10.1055/s-0043-124081
Original article
© Georg Thieme Verlag KG Stuttgart · New York

The size, morphology, site, and access score predicts critical outcomes of endoscopic mucosal resection in the colon

Mayenaaz Sidhu*
Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
,
David J. Tate*
Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
,
Lobke Desomer
Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
,
Gregor Brown
Department of Gastroenterology and Hepatology, The Alfred Hospital, Melbourne, Victoria, Australia
Department of Gastroenterology and Hepatology, Epworth Hospital, Melbourne, Victoria, Australia
,
Luke F. Hourigan
Department of Gastroenterology and Hepatology, Greenslopes Private Hospital, Brisbane, Queensland, Australia
Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
,
Eric Y. T. Lee
Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
,
Alan Moss
Department of Gastroenterology and Hepatology, Footscray Hospital, Melbourne, Victoria, Australia
Department of Medicine, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
,
Spiro Raftopoulos
Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
,
Rajvinder Singh
Department of Gastroenterology and Hepatology, Lyell McEwan Hospital, Adelaide, South Australia, Australia
,
Stephen J. Williams
Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
,
Simon Zanati
Department of Gastroenterology and Hepatology, The Alfred Hospital, Melbourne, Victoria, Australia
Department of Gastroenterology and Hepatology, Footscray Hospital, Melbourne, Victoria, Australia
,
Nicholas Burgess
Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
,
Michael J. Bourke
Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
› Author Affiliations
Further Information

Publication History

submitted 01 September 2017

accepted after revision 19 November 2017

Publication Date:
25 January 2018 (eFirst)

Abstract

Background The SMSA (size, morphology, site, access) polyp scoring system is a method of stratifying the difficulty of polypectomy through assessment of four domains. The aim of this study was to evaluate the ability of SMSA to predict critical outcomes of endoscopic mucosal resection (EMR).

Methods We retrospectively applied SMSA to a prospectively collected multicenter database of large colonic laterally spreading lesions (LSLs) ≥ 20 mm referred for EMR. Standard inject-and-resect EMR procedures were performed. The primary end points were correlation of SMSA level with technical success, adverse events, and endoscopic recurrence.

Results 2675 lesions in 2675 patients (52.6 % male) underwent EMR. Failed single-session EMR occurred in 124 LSLs (4.6 %) and was predicted by the SMSA score (P < 0.001). Intraprocedural and clinically significant postendoscopic bleeding was significantly less common for SMSA 2 LSLs (odds ratio [OR] 0.36, P < 0.001 and OR 0.23, P < 0.01) and SMSA 3 LSLs (OR 0.41, P  < 0.001 and OR 0.60, P = 0.05) compared with SMSA 4 lesions. Similarly, endoscopic recurrence at first surveillance was less likely among SMSA 2 (OR 0.19, P < 0.001) and SMSA 3 (OR 0.33, P < 0.001) lesions compared with SMSA 4 lesions. This also extended to second surveillance among SMSA 4 LSLs.

Conclusion SMSA is a simple, readily applicable, clinical score that identifies a subgroup of patients who are at increased risk of failed EMR, adverse events, and adenoma recurrence at surveillance colonoscopy. This information may be useful for improving informed consent, planning endoscopy lists, and developing quality control measures for practitioners of EMR, with potential implications for EMR benchmarking and training.

* These authors contributed equally to this work.