Original Articles
Efficacy, safety, and clinical outcomes of endoscopic mucosal resection: A study of 101 cases

Presented in part at the annual meeting of the American Society of Gastrointestinal Endoscopy, Digestive Diseases Week, May 20-23, 2001, Atlanta, Georgia (Gastrointest Endosc 2001;53:AB63).
https://doi.org/10.1067/mge.2002.121881Get rights and content

Abstract

Background: Endoscopic mucosal resection (EMR) is an alternative to surgery for removal of superficial neoplastic lesions of the GI tract. The aim of this study was to assess the safety, efficacy, and clinical outcomes of EMR. Methods: Data from consecutive EMR procedures performed by using suction cap-assisted and/or saline solution-assisted snare resection techniques over a 45-month period were reviewed retrospectively. EUS was performed before EMR in the majority of cases. Immediate and delayed complications were recorded. Survival was assessed in patients with carcinoma or high-grade dysplasia on final histopathology in whom EMR achieved complete resection. Results: One hundred one lesions were removed by EMR in 92 patients. Indications were adenoma (67%), high-grade dysplasia (13%), intramucosal carcinoma (11%), and lesions of uncertain histopathology (10%). Locations were esophagus 19%, stomach 14%, duodenum 27%, rectum 12%, and colon 29%. Suction cap-assisted technique was used in 26% and saline solution-assisted polypectomy in 74% of cases. Complete resection was achieved in 89%. For complete resection, 17% required more than 1 session. Post-EMR histopathology was adenoma 47%, high-grade dysplasia 13%, carcinoma 16%, carcinoid 3%, benign 19%, and low-grade dysplasia 3%. EMR resulted in upgrading of histopathologic staging to carcinoma or high-grade dysplasia in 44%. Bleeding was the only complication (early 16, delayed 6). The median cancer-free survival in patients with adenocarcinoma who underwent complete resection by EMR was 27 months (interquartile range: 17-28 months). Conclusion: EMR achieves complete resection in a majority of patients but is associated with a higher risk of bleeding compared with standard polypectomy. EMR changes pathologic stage in a significant number of patients. Survival data are encouraging, but long-term follow-up studies are needed. (Gastrointest Endosc 2002;55:390-6.)

Section snippets

Patients and methods

Data from 92 consecutive patients referred for EMR between February 1997 and September 2000 were retrospectively reviewed. The institutional review board of our hospital approved the data analysis and the reporting. All cases in which EMR was attempted or performed were included. Patients who had incomplete EMR at other institutions and were subsequently referred were also included. All lesions had been identified at prior endoscopic examinations, either at our institution or by referring

Results

One hundred one lesions were removed from 92 patients (Table 1).

. Patient and lesion demographics

Patients (n = 92)
VariablePatients (%)
Average age in y (range)65 (25-88)
Male gender53 (58)
Lesion location (n = 101)
 Esophagus19 (19)
 Stomach14 (14)
 Duodenum27 (27)
 Colon29 (29)
 Rectum12 (12)
Indication
 Adenocarcinoma11 (11)
 HGD13 (13)
 Lesion of unknown pathology10 (10)
 Adenoma67 (67)
Size (cm)2 (0.5-7)
Morphology
 Flat6 (6)
 Nodular21 (21)
 Sessile70 (70)
 Carpet-like4 (4)
There were 28 (30%) patients who had comorbid

Discussion

EMR is an alternative to surgery for patients with superficial neoplastic lesions of the digestive tract not amenable to endoscopic resection with standard electrocautery snare techniques. EMR has an advantage over endoscopic ablation therapy in that it provides a specimen for histologic analysis. By using such adjunctive elements as submucosal saline solution injection, modified snares, and suction cap devices, CR of an array of challenging lesions from throughout the digestive tract can be

Cited by (339)

  • Polypectomy for Large Polyps with Endoscopic Mucosal Resection

    2022, Gastrointestinal Endoscopy Clinics of North America
  • Advances in gastrointestinal surgical endoscopy

    2021, Annals of Medicine and Surgery
View all citing articles on Scopus

Reprint requests: Gregory G. Ginsberg, MD, Division of Gastroenterology, Ravdin 3, Hospital of University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104.

View full text