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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. 1 Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
  2. 2 Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
  3. 3 Department 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}

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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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  • Contributors FFB, SJH and MJB all contributed equally to write the letter response.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Western Sydney Local Health District Human Research and Ethics Committee.

  • Provenance and peer review Not commissioned; internally peer reviewed.