Introduction Endoscopic Mucosal Resection (EMR) is now well established as the procedure of choice for removing flat and sessile polyps in the colon. It stems from large scale studies in Japan that is increasingly practised in the UK, thus potentially avoiding surgery for benign polyps. Our aim was to assess the safety, efficacy and clinical outcomes of EMR procedures at Nottingham University Hospitals NHS Trust.
Methods We searched our prospectively collected database for all sessile and flat colonic polyps >10 mm (Paris0–Is, 0–II) removed by injection and snare EMR technique in our centre over a 7-year period (2004–2011). Follow-up examinations were done as per BSG guidelines. Parameters analysed included patient's demographics; type of resection; completeness of resection; endoscopic success rate; as well as recurrence and complication rates.
Results All procedures were done by endoscopists trained in EMR. 338 EMRs were done in 325 patients, age range 20–90 yrs, male 55% (180). 77% (261) had sedation and one patient had GA for the procedure. 53% (180) had en bloc resection, 39% (132) had piecemeal while 4.7% (16) had incomplete or partial resection. 2.9% (10) were unable to resect. Endoscopic success at 1st attempt was achieved in 82% (278) and over all endoscopic cure was 92% (310). 4.4% (15) were referred for surgery. A follow-up procedure was performed in 77% (242) within 12 months Recurrence rate for enbloc resection was 5.7% (9/156), for piecemeal resection it was 18% (16/86). Overall recurrence rate was 10.3% (25/242). Adenocarcinoma was present in 4.1% (14) patients while in eight of these patients had complete resection with no evidence of recurrence at follow-up. Over all Complication rate was 9.1% (31). 6.5% (22) had immediate bleeding requiring therapy. 15/22 were left sided Polyps (11 rectum, 4 sigmoid) with mean size >20 mm. 1.1% (4) patients had delayed bleeding. While two required repeat colonoscopy and haemostasis one had right hemicolectomy as bleeding was complicated by delayed perforation. 0.5% (2) patients had immediate while one patient had delayed perforation at second day requiring surgery. There was no procedure related death.
Conclusion EMR is effective and safe therapy in well trained hands with minor and acceptable complication rate. There is high recurrence rate especially after piecemeal resection within the first 12 months that requires a strict follow-up protocol. Rectal polyps and size >20 mm were associated with high risk of bleeding. Currently there are no guidelines and standards measuring EMR outcome. Nationwide EMR audit/database is needed to help form recommendations.
Competing interests None declared.
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