TY - JOUR T1 - Randomised controlled trial of transanal endoscopic microsurgery versus endoscopic mucosal resection for large rectal adenomas (TREND Study) JF - Gut JO - Gut SP - 837 LP - 846 DO - 10.1136/gutjnl-2016-313101 VL - 67 IS - 5 AU - Renée M Barendse AU - Gijsbert D Musters AU - Eelco J R de Graaf AU - Frank J C van den Broek AU - Esther C J Consten AU - Pascal G Doornebosch AU - James C Hardwick AU - Ignace H J T de Hingh AU - Chrisiaan Hoff AU - Jeroen M Jansen AU - A W Marc van Milligen de Wit AU - George P van der Schelling AU - Erik J Schoon AU - Matthijs P Schwartz AU - Bas L A M Weusten AU - Marcel G Dijkgraaf AU - Paul Fockens AU - Willem A Bemelman AU - Evelien Dekker A2 - , Y1 - 2018/05/01 UR - http://gut.bmj.com/content/67/5/837.abstract N2 - Objective Non-randomised studies suggest that endoscopic mucosal resection (EMR) is equally effective in removing large rectal adenomas as transanal endoscopic microsurgery (TEM), but EMR might be more cost-effective and safer. This trial compares the clinical outcome and cost-effectiveness of TEM and EMR for large rectal adenomas.Design Patients with rectal adenomas ≥3 cm, without malignant features, were randomised (1:1) to EMR or TEM, allowing endoscopic removal of residual adenoma at 3 months. Unexpected malignancies were excluded postrandomisation. Primary outcomes were recurrence within 24 months (aiming to demonstrate non-inferiority of EMR, upper limit 10%) and the number of recurrence-free days alive and out of hospital.Results Two hundred and four patients were treated in 18 university and community hospitals. Twenty-seven (13%) had unexpected cancer and were excluded from further analysis. Overall recurrence rates were 15% after EMR and 11% after TEM; statistical non-inferiority was not reached. The numbers of recurrence-free days alive and out of hospital were similar (EMR 609±209, TEM 652±188, p=0.16). Complications occurred in 18% (EMR) versus 26% (TEM) (p=0.23), with major complications occurring in 1% (EMR) versus 8% (TEM) (p=0.064). Quality-adjusted life years were equal in both groups. EMR was approximately €3000 cheaper and therefore more cost-effective.Conclusion Under the statistical assumptions of this study, non-inferiority of EMR could not be demonstrated. However, EMR may have potential as the primary method of choice due to a tendency of lower complication rates and a better cost-effectiveness ratio. The high rate of unexpected cancers should be dealt with in further studies. ER -