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Wide-field endoscopic mucosal resection versus endoscopic submucosal dissection for laterally spreading colorectal lesions: a cost-effectiveness analysis
  1. Farzan F Bahin1,2,
  2. Steven J Heitman1,3,
  3. Michael J Bourke1,2
  1. 1Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
  2. 2Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
  3. 3Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  1. Correspondence to Dr Michael J Bourke, Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, NSW 2145, Australia; michael{at}citywestgastro.com.au

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We thank Jacques and colleagues for their critical appraisal of our manuscript.1 2 Although recurrence is a shortcoming of wide-field endoscopic mucosal resection (WF-EMR), it is typically unifocal, diminutive and its management does not add substantial cost beyond that of the surveillance colonoscopy. Our base case rate of 14.4% was determined from our large prospective WF-EMR cohort and is consistent with a recent meta-analysis (13.8%).3 We modelled recurrence rates following endoscopic submucosal dissection (ESD) that were six- to sevenfold lower and in line with the rates quoted by the French group. Our modelled assumptions reflect contemporary evidence and favour ESD given adjunctive thermal ablation of the post-EMR margin4 has been shown to reduce recurrence following WF-EMR to 5%–6% including for larger lesions.

ESD is a …

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