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Impact of en bloc resection on long-term outcomes after endoscopic mucosal resection: a matched cohort study.
Tate, David J; Sidhu, Mayenaaz; Bar-Yishay, Iddo; Desomer, Lobke; Brown, Gregor; Hourigan, Luke F; Lee, Eric Y T; Moss, Alan; Raftopoulos, Spiro; Singh, Rajvinder; Williams, Stephen J; Zanati, Simon; Burgess, Nicholas; Bourke, Michael J.
Afiliação
  • Tate DJ; Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia; Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia; Department of Gastroenterology and Hepatology, University Hospital of Gent, Gent, Belgium.
  • Sidhu M; Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia; Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia.
  • Bar-Yishay I; Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia.
  • Desomer L; Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia.
  • Brown G; Department of Gastroenterology and Hepatology, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Gastroenterology and Hepatology, Epworth Hospital, Melbourne, Victoria, Australia.
  • Hourigan LF; Department of Gastroenterology and Hepatology, Greenslopes Private Hospital, Brisbane, Queensland, Australia; Gallipoli Medical Research Institute, School of Medicine, The University of Queensland, Greenslopes Private Hospital, Brisbane, Queensland, Australia.
  • Lee EYT; Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia.
  • Moss A; Department of Gastroenterology and Hepatology, Footscray Hospital, Melbourne, Victoria, Australia; Department of Medicine, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.
  • Raftopoulos S; Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
  • Singh R; Department of Gastroenterology and Hepatology, Lyell McEwan Hospital, Adelaide, South Australia, Australia.
  • Williams SJ; Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia.
  • Zanati S; Department of Gastroenterology and Hepatology, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Gastroenterology and Hepatology, Footscray Hospital, Melbourne, Victoria, Australia.
  • Burgess N; Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia; Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia.
  • Bourke MJ; Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia; Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia.
Gastrointest Endosc ; 91(5): 1155-1163.e1, 2020 05.
Article em En | MEDLINE | ID: mdl-31887274
ABSTRACT
BACKGROUND AND

AIMS:

Residual or recurrent adenoma (RRA) is the major limitation of piecemeal EMR (p-EMR) for large colonic laterally spreading lesions (LSLs) ≥20 mm. En bloc EMR (e-EMR) has been shown to achieve low rates of RRA but specific procedural and long-term outcomes are unknown. Our aim was to compare long-term outcomes of size-matched LSLs stratified by whether they were resected e-EMR or p-EMR.

METHODS:

Data from a prospective tertiary referral multicenter cohort of large LSLs referred for EMR over a 10-year period were analyzed. Outcomes were compared between sized-matched LSLs (20-25 mm) resected by p-EMR or e-EMR.

RESULTS:

Five hundred seventy LSLs met the inclusion criteria of which 259 (45.4%) were resected by e-EMR. The risk of major deep mural injury (DMI) was significantly higher in the e-EMR group (3.5% vs 1.0%, P = .05), whereas rates of other intraprocedural adverse events did not differ significantly. Five of 9 (56%) LSLs, with endoscopic features of submucosal invasion (SMI), resected by e-EMR were saved from surgery. RRA at first surveillance was lower in the e-EMR group (2.0% vs 5.7%, P = .04), but this difference was negated at subsequent surveillance. Rates of surgical referral were not significantly different between the groups at either surveillance interval.

CONCLUSION:

When comparing e-EMR against p-EMR for lesions ≤25 mm in size of similar morphology in a large prospective multicenter cohort, e-EMR offered no additional advantage for predicted-benign LSLs. However, it was associated with an increased risk of major DMI. Thus, en bloc resection techniques should be reserved for lesions suspicious for invasive disease. (Clinical trial registration number NCT01368289.).
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Ressecção Endoscópica de Mucosa Tipo de estudo: Clinical_trials / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Humans Idioma: En Revista: Gastrointest Endosc Ano de publicação: 2020 Tipo de documento: Article País de afiliação: Bélgica
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Ressecção Endoscópica de Mucosa Tipo de estudo: Clinical_trials / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Humans Idioma: En Revista: Gastrointest Endosc Ano de publicação: 2020 Tipo de documento: Article País de afiliação: Bélgica