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|Title:||Endoscopic mucosal resection for large serrated lesions in comparison with adenomas: a prospective multicentre study of 2000 lesions.|
|Other Authors:||Pellise, Maria|
|Keywords:||Department of Gastroenterology and Hepatology, Epworth HealthCare, Victoria, Australia|
Endoscopic Mucosal Resection
Laterally Spreading Flat and Sessile Lesions
Sessile Serrated Adenomas/ Polyps
Large Conventional Adenomas
|Publisher:||British Society of Gastroenterology, and BMJ|
|Citation:||Gut. 2016 Jan 19. pii: [Epub ahead of print]|
|Abstract:||OBJECTIVE: Endoscopic mucosal resection (EMR) is effective for large laterally spreading flat and sessile lesions (LSLs). Sessile serrated adenomas/polyps (SSA/Ps) are linked to the relative failure of colonoscopy to prevent proximal colorectal cancer. We aimed to examine the technical success, adverse events and recurrence following EMR for large SSA/Ps in comparison with large conventional adenomas. DESIGN: Over 74 months till August 2014, prospective multicentre data of LSLs ≥20 mm were analysed. A standardised dye-based conventional EMR technique followed by scheduled surveillance colonoscopy was used. RESULTS: From a total of 2000 lesions, 323 SSA/Ps in 246 patients and 1527 adenomas in 1425 patients were included for analysis. Technical success for EMR was superior in SSA/Ps compared with adenomas (99.1% vs 94.5%, p<0.001). Significant bleeding and perforation were similar in both cohorts. The cumulative recurrence rates for adenomas after 6, 12, 18 and 24 months were 16.1%, 20.4%, 23.4% and 28.4%, respectively. For SSA/Ps, they were 6.3% at 6 months and 7.0% from 12 months onwards (p<0.001). Following multivariable adjustment, the HR of recurrence for adenomas versus SSA/Ps was 1.7 (95% CI 0.9 to 3.0, p=0.097). Subgroup analysis by lesion size revealed an eightfold increased risk of recurrence for 20-25 mm adenomas versus SSA/Ps, but no significantly different risk between lesion types in larger lesion groups. CONCLUSION: Recurrence after EMR of 20-25 mm LSLs is significantly less frequent in SSA/Ps compared with adenomatous lesions. SSA/Ps can be more effectively removed than adenomatous LSLs with equivalent safety. Ensuring complete initial resection is imperative for avoiding recurrence. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT01368289.|
|Affiliated Organisations:||Departments of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia.|
Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia.
Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Department of Gastroenterology and Hepatology, Greenslopes Private Hospital, Brisbane, Queensland, Australia.
Department of Gastroenterology and Hepatology, The Alfred Hospital, Melbourne, Victoria, Australia
Department of Gastroenterology and Hepatology, Western Hospital, Melbourne, Victoria, Australia.
Department of Gastroenterology and Hepatology, Lyell McEwin Hospital, Adelaide, South Australia, Australia.
Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia.
Research and Education Network, Westmead Hospital, Sydney, New South Wales, Australia.
Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, New South Wales, Australia.
|Type of Clinical Study or Trial:||Multicentre Studies|
|Appears in Collections:||Cancer Services|
General Surgery and Gastroenterology
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