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Endoscopic mucosal resection for large serrated lesions in comparison with adenomas: a prospective multicentre study of 2000 lesions
  1. Maria Pellise1,
  2. Nicholas G Burgess1,2,
  3. Nicholas Tutticci1,
  4. Luke F Hourigan3,4,
  5. Simon A Zanati5,6,
  6. Gregor J Brown5,7,
  7. Rajvinder Singh8,
  8. Stephen J Williams1,
  9. Spiro C Raftopoulos9,
  10. Donald Ormonde9,
  11. Alan Moss6,
  12. Karen Byth10,11,
  13. Heok P'Ng12,
  14. Hema Mahajan12,
  15. Duncan McLeod12,
  16. Michael J Bourke1,2
  1. 1Departments of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
  2. 2Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
  3. 3Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
  4. 4Department of Gastroenterology and Hepatology, Greenslopes Private Hospital, Brisbane, Queensland, Australia
  5. 5Department of Gastroenterology and Hepatology, The Alfred Hospital, Melbourne, Victoria, Australia
  6. 6Department of Gastroenterology and Hepatology, Western Hospital, Melbourne, Victoria, Australia
  7. 7Department of Gastroenterology and Hepatology, Epworth Hospital, Melbourne, Victoria, Australia
  8. 8Department of Gastroenterology and Hepatology, Lyell McEwin Hospital, Adelaide, South Australia, Australia
  9. 9Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
  10. 10NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia.
  11. 11Research and Education Network, Westmead Hospital, Sydney, New South Wales, Australia
  12. 12Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, New South Wales, Australia
  1. Correspondence to Professor Michael J Bourke, Department of Gastroenterology and Hepatology, Westmead Hospital, c/- Suite 106a, 151-155 Hawkesbury Road, Westmead, Sydney, NSW 2143, Australia; michael{at}


Objective Endoscopic mucosal resection (EMR) is effective for large laterally spreading flat and sessile lesions (LSLs). Sessile serrated adenomas/polyps (SSA/Ps) are linked to the relative failure of colonoscopy to prevent proximal colorectal cancer. We aimed to examine the technical success, adverse events and recurrence following EMR for large SSA/Ps in comparison with large conventional adenomas.

Design Over 74 months till August 2014, prospective multicentre data of LSLs ≥20 mm were analysed. A standardised dye-based conventional EMR technique followed by scheduled surveillance colonoscopy was used.

Results From a total of 2000 lesions, 323 SSA/Ps in 246 patients and 1527 adenomas in 1425 patients were included for analysis. Technical success for EMR was superior in SSA/Ps compared with adenomas (99.1% vs 94.5%, p<0.001). Significant bleeding and perforation were similar in both cohorts. The cumulative recurrence rates for adenomas after 6, 12, 18 and 24 months were 16.1%, 20.4%, 23.4% and 28.4%, respectively. For SSA/Ps, they were 6.3% at 6 months and 7.0% from 12 months onwards (p<0.001). Following multivariable adjustment, the HR of recurrence for adenomas versus SSA/Ps was 1.7 (95% CI 0.9 to 3.0, p=0.097). Subgroup analysis by lesion size revealed an eightfold increased risk of recurrence for 20–25 mm adenomas versus SSA/Ps, but no significantly different risk between lesion types in larger lesion groups.

Conclusion Recurrence after EMR of 20–25 mm LSLs is significantly less frequent in SSA/Ps compared with adenomatous lesions. SSA/Ps can be more effectively removed than adenomatous LSLs with equivalent safety. Ensuring complete initial resection is imperative for avoiding recurrence.

Trial registration number NCT01368289.


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