Identifying risk factors for recurrence in colonic lesions≥20 mm treated with piecemeal EMR: a single-center study

Aims Piecemeal endoscopic mucosal resection (pEMR) is widely used for the removal of colonic lesions. Despite its effectiveness, recurrence remains a significant concern in clinical practice, and identifying factors associated with recurrence is essential for improving patient outcomes and guiding treatment strategies. The Sydney EMR Recurrence Tool (SERT) offers a standardised method for assessing recurrence risk [1]. This study aimed to analyse the recurrence rate in patients with colonic lesions≥20 mm who underwent pEMR and had an endoscopic follow-up, and to evaluate lesion characteristics potentially involved in recurrence.

Methods Data from 63 patients who underwent pEMR for colonic lesions≥20 mm at a non-tertiary centre between January 2021 and February 2024 were analysed. Patient demographics, lesion characteristics and recurrence at follow-up were examined using statistical methods, including the chi-square test and t-test, with risk assessment supported by SERT.

Results Of the 63 patients, 62.5% were male and 37.5% were female; mean age was 67.6 years. The lesions were predominantly located in the ascending colon (49.2%), and follow-up endoscopy was performed at a median of 7 months (IQR 6–8 months). The overall recurrence rate was 23.8% (15 out of 63 patients) and it was significantly (p=0.024) associated with the location of the lesions, with the ascending colon, hepatic flexure, and rectum showing the highest rates of recurrence. A significant relationship was also found between recurrence and lesion size (p=0.026), with lesions≥60 mm demonstrating a stronger correlation with recurrence. High-grade dysplasia was linked to a higher recurrence rate compared to low-grade dysplasia (p=0.031). Intraprocedural bleeding occurred in one patient only, who did not experience recurrence. No statistically significant relationships were observed between recurrence and lesion type according to the Paris classification, LST type, sex, or age.

Conclusions This study highlights the importance of SERT in identifying high-risk colonic lesions, emphasising the need for targeted surveillance and tailored interventions to improve post-pEMR patient care.

Publication History

Article published online:
27 March 2025

• References

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