Abstract
Background
Endoscopic mucosal resection (EMR) is used for treatment of sessile and flat colonic adenomas. There is limited data comparing polyp recurrence between piecemeal and en-bloc resections.
Aim
The purpose of this study was to evaluate the incidence density and predictive factors for polyp recurrence after piecemeal and en-bloc resections.
Methods
Patients undergoing EMR of flat or sessile adenomas ≥10 mm were included. Incidence density (ID) and incidence rate ratio (IRR) of polyp recurrence were calculated. Predictive factors for recurrence were assessed by multivariate analysis using logistic regression.
Results
A total of 105 patients (males 54, mean age 68) with 121 polyps were included. Sixty-seven polyps (mean size ± SD, 23.3 ± 9.2 mm) were resected piecemeal and 54 polyps (mean size 14.7 ± 5.1 mm) were resected en-bloc. There were 12 recurrences in the piecemeal group and two in the en-bloc group. The ID of polyp recurrence in the piecemeal group was 13.1 (95% CI 7.43–23.03) and in the en-bloc group was 2.7 (95% CI 0.67–10.78) per 100 person-years of follow-up. Piecemeal resections were 5.5 (95% CI 1.1–30.48, P = 0.045) times and flat polyps were 6.6 (95% CI 1.22–35.53, P = 0.028) times more likely to result in recurrence compared to en-bloc resections and sessile polyps, respectively. In the piecemeal group, additional use of argon plasma coagulation (APC) did not affect the recurrence (OR 0.46, P = 0.29).
Conclusions
Piecemeal resections and flat polyps are associated with higher recurrence following EMR. Additional use of APC did not affect the recurrence rates after piecemeal resection.
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Conflict of interest
Dr K. Ragunath has received speaker honoraria, research support and educational grants from Olympus-Keymed UK, Cook Medical UK, Astra-Zeneca UK and BARRX Medical, USA. Drs J. Mannath, V. Subramanian, R. Singh and E. Telakis have nothing to disclose.
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Mannath, J., Subramanian, V., Singh, R. et al. Polyp Recurrence After Endoscopic Mucosal Resection of Sessile and Flat Colonic Adenomas. Dig Dis Sci 56, 2389–2395 (2011). https://doi.org/10.1007/s10620-011-1609-y
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DOI: https://doi.org/10.1007/s10620-011-1609-y