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  • Impact of margin thermal ablation after endoscopic mucosal resection of large (≥20 mm) non-pedunculated colonic polyps on long-term recurrence

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Endoscopy
Original research
Impact of margin thermal ablation after endoscopic mucosal resection of large (≥20 mm) non-pedunculated colonic polyps on long-term recurrence
  1. Timothy O’Sullivan1,2,
  2. Francesco Vito Mandarino1,
  3. Julia L Gauci1,
  4. Anthony M Whitfield1,2,
  5. Clarence Kerrison1,
  6. James Elhindi3,
  7. Catarina Neto do Nascimento1,
  8. Sunil Gupta1,2,
  9. Oliver Cronin1,2,
  10. Anthony Sakiris1,
  11. Juan Francisco Prieto Aparicio1,
  12. Sophie Arndtz4,
  13. Gregor Brown4,
  14. Spiro Raftopoulos5,6,
  15. David Tate7,
  16. Eric Y Lee1,
  17. Stephen J Williams1,
  18. Nicholas Burgess1,2,
  19. Michael J Bourke1,2
  1. 1Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
  2. 2The University of Sydney Westmead Clinical School, Sydney, New South Wales, Australia
  3. 3WSLHD Research and Education Network, Westmead Hospital, Westmead, New South Wales, Australia
  4. 4Gastroenterology and Hepatology, Alfred Hospital, Melbourne, Victoria, Australia
  5. 5Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
  6. 6Curtin Medical School, Perth, Western Australia, Australia
  7. 7Gastroenterology and Hepatology, UZ Gent, Gent, Belgium
  1. Correspondence to Dr Michael J Bourke; michael{at}citywestgastro.com.au

Abstract

Background and aims The efficacy of colorectal endoscopic mucosal resection (EMR) is limited by recurrence and the necessity for conservative surveillance. Margin thermal ablation (MTA) after EMR has reduced the incidence of recurrence at the first surveillance colonoscopy at 6 months (SC1). Whether this effect is durable to second surveillance colonoscopy (SC2) is unknown. We evaluated long-term surveillance outcomes in a cohort of LNPCPs that have undergone MTA.

Methods LNPCPs undergoing EMR and MTA from four academic endoscopy centres were prospectively recruited. EMR scars were evaluated at SC1 and in the absence of recurrence, SC2 colonoscopy was conducted in a further 12 months. A historical control arm was generated from LNPCPs that underwent EMR without MTA. The primary outcome was recurrence at SC2 in all LNPCPs with a recurrence-free scar at SC1.

Results 1152 LNPCPs underwent EMR with complete MTA over 90 months until October 2022. 854 LNPCPs underwent SC1 with 29/854 (3.4%) LNPCPs demonstrating recurrence. 472 LNPCPs free of recurrence at SC1 underwent SC2. 260 LNPCPs with complete SC2 follow-up formed the control arm from January 2012 to May 2016. Recurrence at SC2 was significantly less in the MTA arm versus controls (1/472 (0.2%) vs 9/260 (3.5%); p<0.001)).

Conclusion LNPCPs that have undergone successful EMR with MTA and are free of recurrence at SC1 are unlikely to develop recurrence in subsequent surveillance out to 2 years. Provided the colon is cleared of synchronous neoplasia, the next surveillance can be potentially extended to 3–5 years. Such an approach would reduce costs and enhance patient compliance.

  • COLONOSCOPY
  • COLONIC POLYPS
  • ENDOSCOPIC POLYPECTOMY
  • SURVEILLANCE

Data availability statement

All data and analytical methods relevant to the study are included in the article. Individual participant data will not be shared or made available to other researchers

https://doi.org/10.1136/gutjnl-2024-332907

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    Data availability statement

    All data and analytical methods relevant to the study are included in the article. Individual participant data will not be shared or made available to other researchers

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    Footnotes

    • Contributors Study concept and design: MJB and TO'S. Acquisition of data: MJB, TO'S, FVM, CNdN, JLG, AMW, CK, SG, AS, JFPA, SA, GB, SR, DT, EYL, SJW and NB. Analysis and interpretation of data: TO'S. Drafting of the manuscript: TO'S. Critical revision of the manuscript for important intellectual content: MJB, TO'S, FVM, CNdN, JLG, AMW, CK, SG, AS, JFPA, SA, GB, SR, DT, EYL, SJW and NB. Statistical analysis: TO'S and JE. Study supervision: MJB. MJB is the guarantor author.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests MJB: Research Support: Olympus Medical, Cook Medical, Boston Scientific. GB: Research Support: Olympus Medical. The remaining authors have no financial, professional, or personal conflicts of interest to disclose.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

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