Intest Res.  2017 Oct;15(4):502-510. 10.5217/ir.2017.15.4.502.

Local recurrence and subsequent endoscopic treatment after endoscopic piecemeal mucosal resection with or without precutting in the colorectum

• Seo M
• Song EM
• Kim GU
• Hwang SW
• Park SH
• Yang DH
• Kim KJ
• Ye BD
• Myung SJ
• Yang SK
• Byeon JS

• KMID: 2396400
• DOI: http://doi.org/10.5217/ir.2017.15.4.502

Abstract

BACKGROUND/AIMS
Precutting before endoscopic piecemeal mucosal resection (EPMR) may increase colorectal polyp resection effectiveness. We aimed to identify risk factors for recurrence after conventional EPMR (CEPMR) and precut EPMR (PEPMR) and investigated endoscopic treatment outcomes for recurrent cases.
METHODS
The medical records of patients with colorectal polyps treated by EPMR were analyzed. Patients without follow-up surveillance colonoscopies were excluded.
RESULTS
Among 359 lesions, the local recurrence rate on the first surveillance colonoscopy was 5.8% (18/312) and 6.4% (3/47) after CEPMR and PEPMR, respectively. Among lesions without recurrence at the first surveillance colonoscopy, the rates of late recurrence on subsequent surveillance colonoscopy were 3.9% (6/152) and 0% after CEPMR and PEPMR, respectively. Larger tumor size was the only independent risk factor for recurrence (odds ratio, 7.93; 95% confidence interval, 1.95-32.30; P<0.001). Endoscopic treatment was performed for all 27 recurrences. A combination of ≥2 endoscopic treatment modalities was used in 19 of 27 recurrences (70.4%). Surveillance colonoscopies were performed in 20 of 27 recurrences after endoscopic treatment. One (5.0%) had a re-recurrence and was treated by surgical resection because recurrence occurred at the appendiceal orifice. Nineteen of 20 lesions (95.0%) could be cured endoscopically, although 3 of the 19 showed second or third recurrences and were treated by repeat endoscopic resection.
CONCLUSIONS
The local recurrence rates after CEPMR and PEPMR were similar. Larger tumor size was an independent risk factor for local recurrence after EPMR. Endoscopic treatment of recurrences resulted in high cure rates, although combination methods were necessary in many cases.

Keyword

Endoscopic mucosal resection; Colonic neoplasia; Piecemeal resection

MeSH Terms

Colonoscopy
Follow-Up Studies
Humans
Medical Records
Polyps
Recurrence*
Risk Factors

Figure

• 

  Fig. 1 Flow diagram showing recurrence and subsequent endoscopic treatment. aEarly recurrence (red box) rates at the first surveillance were 5.8% (18/312) and 6.4% (3/47) after conventional endoscopic piecemeal mucosal resection (CEPMR) and precut EPMR (PEPMR), respectively; bAmong lesions without recurrence at the first surveillance colonoscopy, the rates of late recurrence (blue box) were 3.9% (6/152) and 0% after CEPMR and PEPMR, respectively. In summary, the overall recurrence rates were 7.7% (24/312) and 6.4% (3/47) after CEPMR and PEPMR, respectively.

• 

  Fig. 2 Conventional endoscopic piecemeal resection (EPMR) (A-E) and precut EPMR (F-J).

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