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Title: Long-term adenoma recurrance following wide-field endoscopic muscosal resection (WF-EMR) for advanced colonic muscosal neoplasia is infrequent: results and risk factos in 1000 cases from the Australian Colonic EMR (ACE) study.
Epworth Authors: Brown, Gregor
Other Authors: Moss, Alan
Williams, Stephen
Luke, Hourigan
Tam, William
Singh, Rajvinder
Zanati, Simon
Burgess, Nicholas
Sonson, Rebecca
Byth, Karen
Bourke, Michael
Keywords: Wide-Field Endoscopic Mucosal Resection
Colonic Mucosal Neoplasia
Colonic Lesions
Department of Gastroenterology, The Epworth Hospital, Melbourne
Issue Date: Jan-2015
Publisher: BMJ Publishing Group Limited
Citation: Gut. 2015 Jan;64(1):57-65
Abstract: Wide-field endoscopic mucosal resection (WF-EMR) is an alternative to surgery for treatment of advanced colonic mucosal neoplasia up to 120 mm in size, but has been criticised for its potentially high recurrence rates. We aimed to quantify recurrence at 4 months (early) and 16 months (late) following successful WF-EMR and identify its risk factors and clinical significance. Ongoing multicentre, prospective, intention-to-treat analysis of sessile or laterally spreading colonic lesions ≥20 mm in size referred for WF-EMR to seven academic endoscopy units. Surveillance colonoscopy (SC) was performed 4 months (SC1) and 16 months (SC2) after WF-EMR, with photographic documentation and biopsy of the scar. 1134 consecutive patients were enrolled when 1000 successful EMRs were achieved, of whom 799 have undergone SC1. 670 were normal. Early recurrent/residual adenoma was present in 128 (16.0%, 95% CI 13.6% to 18.7%). One case was unknown. The recurrent/residual adenoma was diminutive in 71.7% of cases. On multivariable analysis, risk factors were lesion size >40 mm, use of argon plasma coagulation and intraprocedural bleeding. Of 670 with normal SC1, 426 have undergone SC2, with late recurrence present in 17 cases (4.0%, 95% CI 2.4% to 6.2%). Overall, recurrent/residual adenoma was successfully treated endoscopically in 135 of 145 cases (93.1%, 95% CI 88.1% to 96.4%). If the initial EMR was deemed successful and did not contain submucosal invasion requiring surgery, 98.1% (95% CI 96.6% to 99.0%) were adenoma-free and had avoided surgery at 16 months following EMR. Following colonic WF-EMR, early recurrent/residual adenoma occurs in 16%, and is usually unifocal and diminutive. Risk factors were identified. Late recurrence occurs in 4%. Overall, recurrence was managed endoscopically in 93% of cases. Recurrence is not a significant clinical problem following WF-EMR, as with strict colonoscopic surveillance, it can be managed endoscopically with high success rates. TRIAL REGISTRATION NUMBER: NCT01368289.
DOI: 10.1136/gutjnl-2013-305516
PubMed URL:
ISSN: 0017-5749
Journal Title: Gut
Type: Journal Article
Affiliated Organisations: Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
Department of Endoscopy, Western Health and The University of Melbourne, Melbourne, Australia
Department of Gastroenterology, Princess Alexandra Hospital, Brisbane, Australia
Department of Gastroenterology, The Alfred Hospital, Melbourne, Australia
Department of Gastroenterology, Lyell McEwin Hospital, Adelaide, Australia
Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
Medical Statistician, Research and Education Network, Westmead Hospital and Sydney University, Sydney, New South Wales, Australia
Type of Clinical Study or Trial: Prospective Observational Study
Appears in Collections:Cancer Services

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