Please use this identifier to cite or link to this item: http://hdl.handle.net/11434/648
Title: Endoscopic mucosal resection for large serrated lesions in comparison with adenomas: a prospective multicentre study of 2000 lesions.
Epworth Authors: Brown, Gregor
Other Authors: Pellise, Maria
Burgess, Nicholas
Tutticci, Nicholas
Hourigan, Luke
Zanati, Simon
Singh, Rajvinder
Williams, Stephen
Raftopoulos, Spiro
Ormonde, Donald
Moss, Alan
Byth, Karen
P'Ng, Heok
Mahajan, Hema
McLeod, Duncan
Bourke, Michael
Keywords: Department of Gastroenterology and Hepatology, Epworth HealthCare, Victoria, Australia
Endoscopic Mucosal Resection
EMR
Colonic Polyps
Colonoscopy
Colorectal Adenomas
Colorectal Cancer
Endoscopic Procedures
Laterally Spreading Flat and Sessile Lesions
LSLs
Sessile Serrated Adenomas/ Polyps
SSA/Ps
Large Conventional Adenomas
Gastroenterology
Issue Date: Jan-2016
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.
URI: http://hdl.handle.net/11434/648
DOI: 10.1136/gutjnl-2015-310249
PubMed URL: http://www.ncbi.nlm.nih.gov/pubmed/26786685
ISSN: 1468-3288
Journal Title: Gut
Type: Journal Article
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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