Please use this identifier to cite or link to this item: http://hdl.handle.net/11434/1274
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dc.contributor.authorBrown, Gregor-
dc.contributor.otherTate, David-
dc.contributor.otherDesomer, Lobke-
dc.contributor.otherKlein, Amir-
dc.contributor.otherHourigan, Luke-
dc.contributor.otherLee, Eric-
dc.contributor.otherMoss, Alan-
dc.contributor.otherOrmonde, Donald-
dc.contributor.otherRaftopoulos, Spiro-
dc.contributor.otherSingh, Rajvinder-
dc.contributor.otherWilliams, Stephen-
dc.contributor.otherZanati, Simon-
dc.contributor.otherByth, Karen-
dc.contributor.otherBourke, Michael-
dc.date.accessioned2017-11-29T01:48:32Z-
dc.date.available2017-11-29T01:48:32Z-
dc.date.issued2017-03-
dc.identifier.citationGastrointest Endosc. 2017 Mar;85(3):647-656.e6en_US
dc.identifier.issn0016-5107en_US
dc.identifier.urihttp://hdl.handle.net/11434/1274-
dc.description.abstractBACKGROUND AND AIMS: EMR is the primary treatment of large laterally spreading lesions (LSLs) in the colon. Residual or recurrent adenoma (RRA) is a major limitation. We aimed to identify a robust method to stratify the risk of RRA. METHODS: Prospective multicenter data on consecutive LSLs ≥20 mm removed by piecemeal EMR from 8 Australian tertiary-care centers were included (September 2008 until May 2016). A logistic regression model for endoscopically determined recurrence (EDR) was created on a randomly selected half of the cohort to yield the Sydney EMR recurrence tool (SERT), a 4-point score to stratify the incidence of RRA based on characteristics of the index EMR. SERT was validated on the remainder of the cohort. RESULTS: Analysis was performed on 1178 lesions that underwent first surveillance colonoscopy (SC1) (median 4.9 months, interquartile range [IQR] 4.9-6.2). EDR was detected in 228 of 1178 (19.4%) patients. LSL size ≥40 mm (odds ratio [OR] 2.47; P < .001), bleeding during the procedure (OR 1.78; P = .024), and high-grade dysplasia (OR 1.72; P = .029) were identified as independent predictors of EDR and allocated scores of 2, 1, and 1, respectively to create SERT. Lesions with SERT scores of 0 (SERT = 0) had a negative predictive value of 91.3% for RRA at SC1, and SERT was shown to stratify RRA to specific follow-up intervals by using Kaplan Meier curves (log-rank P < .001). CONCLUSIONS: Guidelines recommend SC1 within 6 months of EMR. SERT accurately stratifies the incidence of RRA after EMR. SERT = 0 lesions could safely undergo first surveillance at 18 months, whereas lesions with SERT scores between 1 and 4 (SERT 1-4) require surveillance at 6 and 18 months.en_US
dc.publisherElsevieren_US
dc.subjectEndoscopically Determined Recurrenceen_US
dc.subjectEDRen_US
dc.subjectLaterally Spreading Lesionen_US
dc.subjectLSLsen_US
dc.subjectAdenomaen_US
dc.subjectSurgeryen_US
dc.subjectPathologyen_US
dc.subjectColonen_US
dc.subjectColonoscopyen_US
dc.subjectEndoscopic Mucosal Resectionen_US
dc.subjectKaplan-Meier Estimateen_US
dc.subjectLogistic Modelsen_US
dc.subjectNeoplasm Recurrence, Localen_US
dc.subjectEpidemiologyen_US
dc.subjectNeoplasm, Residualen_US
dc.subjectPrecancerous Conditionsen_US
dc.subjectRisk Assessmenten_US
dc.subjectTumor Burdenen_US
dc.subjectColonic Neoplasmsen_US
dc.subjectEMRen_US
dc.subjectSydney EMR Recurrence Toolen_US
dc.subjectSERTen_US
dc.subjectResidual or Recurrent Adenomaen_US
dc.subjectRRAen_US
dc.subjectHistologically Determined Recurrenceen_US
dc.subjectDepartment of Gastroenterology and Hepatology, Epworth Hospital, Melbourne VIC, Australia.en_US
dc.subjectCancer Services Clinical Institute, Epworth HealthCare, Victoria, Australiaen_US
dc.titleAdenoma recurrence after piecemeal colonic EMR is predictable: the Sydney EMR recurrence tool.en_US
dc.typeJournal Articleen_US
dc.identifier.doi10.1016/j.gie.2016.11.027en_US
dc.identifier.journaltitleGastrointestinal Endoscopyen_US
dc.description.pubmedurihttps://www.ncbi.nlm.nih.gov/pubmed/27908600en_US
dc.description.affiliatesDepartment of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia.en_US
dc.description.affiliatesWestmead Clinical School, The University of Sydney Medical School, Sydney, New South Wales, Australia.en_US
dc.description.affiliatesDepartment of Gastroenterology and Hepatology, The Alfred Hospital, Melbourne, Victoria, Australia.en_US
dc.description.affiliatesDepartment of Gastroenterology and Hepatology, Greenslopes Private Hospital, Brisbane, Queensland, Australia.en_US
dc.description.affiliatesDepartment of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.en_US
dc.description.affiliatesDepartment of Gastroenterology and Hepatology, The Western Hospital, Melbourne, Victoria, Australia.en_US
dc.description.affiliatesDepartment of Medicine, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.en_US
dc.description.affiliatesDepartment of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.en_US
dc.description.affiliatesDepartment of Gastroenterology and Hepatology, Lyell McEwan Hospital, Adelaide, South Australia, Australia.en_US
dc.description.affiliatesResearch and Education Network, Westmead Hospital and The University of Sydney, New South Wales, Australia.en_US
dc.type.studyortrialMulticentre Studiesen_US
dc.type.contenttypeTexten_US
Appears in Collections:Cancer Services
General Surgery and Gastroenterology

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