A novel tool for case selection in endoscopic mucosal resection training.
Endoscopy
; 55(12): 1095-1102, 2023 Dec.
Article
in En
| MEDLINE
| ID: mdl-37391184
ABSTRACT
BACKGROUND:
As endoscopic mucosal resection (EMR) of large (≥â20âmm) adenomatous nonpedunculated colonic polyps (LNPCPs) becomes widely practiced outside expert centers, appropriate training is necessary to avoid failed resection and inappropriate surgical referral. No EMR-specific tool guides case selection for endoscopists learning EMR. This study aimed to develop an EMR case selection score (EMR-CSS) to identify potentially challenging lesions for "EMR-naïve" endoscopists developing competency.METHODS:
Consecutive EMRs were recruited from a single center over 130 months. Lesion characteristics, intraprocedural data, and adverse events were recorded. Challenging lesions with intraprocedural bleeding (IPB), intraprocedural perforation (IPP), or unsuccessful resection were identified and predictive variables identified. Significant variables were used to form a numerical score and receiver operating characteristic curves were used to generate cutoff values.RESULTS:
Of 1993 LNPCPs, 286 (14.4â%) were in challenging locations (anorectal junction, ileocecal valve, or appendiceal orifice), 368 (18.5â%) procedures were complicated by IPB and 77 (3.9â%) by IPP; 110 (5.5â%) procedures were unsuccessful. The composite end point of IPB, IPP, or unsuccessful EMR was present in 526 cases (26.4â%). Lesion size, challenging location, and sessile morphology were predictive of the composite outcome. A six-point score was generated with a cutoff value of 2 demonstrating 81â% sensitivity across the training and validation cohorts.CONCLUSIONS:
The EMR-CSS is a novel case selection tool for conventional EMR training, which identifies a subset of adenomatous LNPCPs that can be successfully and safely attempted in early EMR training.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Rectal Neoplasms
/
Colorectal Neoplasms
/
Adenoma
/
Colonic Polyps
/
Adenomatous Polyps
/
Endoscopic Mucosal Resection
Type of study:
Prognostic_studies
Limits:
Humans
Language:
En
Journal:
Endoscopy
Year:
2023
Document type:
Article
Affiliation country: