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Shichijo S, Yamaguchi S, Nakamatsu D, Inoue T, Nakahara M, Ogiyama H, Yamada T, Kinoshita K, Ishihara R, Michida T, Nishida T, Tsujii Y, Hayashi Y, Shinzaki S, Fukui K, Ito Y, Kitamura M, Honma K, Morii E, Takehara T. Local recurrence after endoscopic resection of sessile serrated lesions: A multicenter prospective study by the Osaka Gut Forum. J Gastroenterol Hepatol 2022; 37:2306-2312. [PMID: 36266771 DOI: 10.1111/jgh.16032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/01/2022] [Accepted: 10/16/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Sessile serrated lesions (SSLs) act as precursors to colorectal cancer, sometimes harbor carcinomas, and are sometimes incompletely resected. We aimed to evaluate local recurrence after endoscopic resection of SSL ≥10 mm. METHODS This prospective, single-arm, observational study was performed at eight Japanese tertiary institutions. Colorectal lesions ≥10 mm were resected endoscopically, and the pathological diagnosis was either an SSL or hyperplastic polyp (HP). Follow-up colonoscopy was performed 1 year later, and the local recurrence was evaluated by biopsy. RESULTS From October 2018 to September 2021, 104 cases with 123 lesions were registered. Among the pathologically diagnosed 105 SSLs and 18 HPs, 95 and 7 lesions were diagnosed as SSLs and HPs, respectively, by central pathological review. Among the 104 endoscopically diagnosed SSLs, 86 were diagnosed as SSLs, whereas among the 11 endoscopically diagnosed HPs, two were diagnosed as HPs by central pathological review (the rest were SSLs). Among the 95 patients with 113 lesions who underwent follow-up colonoscopy, resection scars were identified in 95 (84%) lesions. Three (3.1%; 95% confidence interval 0.6-8.7%) local recurrences were diagnosed pathologically among 98 pathologically diagnosed SSLs. Two (6%) local recurrences were diagnosed in patients with SSLs ≥20 mm. CONCLUSIONS The local recurrence rate after endoscopic resection of SSLs ≥10 mm was 3.1%. Careful follow-up is recommended after endoscopic resection of large SSLs. Endoscopically diagnosed HPs ≥10 mm were sometimes pathologically diagnosed as SSL and should be considered for resection.
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Affiliation(s)
- Satoki Shichijo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Shinjiro Yamaguchi
- Department of Gastroenterology, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Dai Nakamatsu
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Takanori Inoue
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masanori Nakahara
- Department of Gastroenterology, Ikeda Municipal Hospital, Osaka, Japan
| | - Hideharu Ogiyama
- Department of Gastroenterology, Itami City Hospital, Itami, Hyogo, Japan
| | - Takuya Yamada
- Department of Gastroenterology, Osaka Rosai Hospital, Osaka, Japan
| | | | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Tomoki Michida
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Tsutomu Nishida
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Yoshiki Tsujii
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshito Hayashi
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shinichiro Shinzaki
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Keisuke Fukui
- Center for Cancer Control and Statistics, Osaka International Cancer Institute, Osaka, Japan
- Department of Mathematics Program, Graduate School of Advanced Science and Engineering, Hiroshima University, Hiroshima, Japan
| | - Yuri Ito
- Center for Cancer Control and Statistics, Osaka International Cancer Institute, Osaka, Japan
- Department of Medical Statistics, Research and Development Center, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Masanori Kitamura
- Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
| | - Keiichiro Honma
- Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
- Department of Pathology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Eiichi Morii
- Department of Pathology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tetsuo Takehara
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
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Thoguluva Chandrasekar V, Aziz M, Patel HK, Sidhu N, Duvvuri A, Dasari C, Kennedy KF, Ashwath A, Spadaccini M, Desai M, Jegadeesan R, Sathyamurthy A, Vennalaganti P, Kohli D, Hassan C, Pellise M, Repici A, Sharma P, Bourke MJ. Efficacy and Safety of Endoscopic Resection of Sessile Serrated Polyps 10 mm or Larger: A Systematic Review and Meta-Analysis. Clin Gastroenterol Hepatol 2020; 18:2448-2455.e3. [PMID: 31786330 DOI: 10.1016/j.cgh.2019.11.041] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/07/2019] [Accepted: 11/10/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The best method for endoscopic resection of sessile serrated polyps (SSP) 10 mm or larger is unclear; studies report variable outcomes in comparison to conventional adenomas. We performed a systematic review and meta-analysis to assess the efficacy and safety of resection of SSPs 10 mm or larger in size. METHODS We searched the PubMed/MEDLINE, Google Scholar, Embase, and Cochrane databases for studies reporting data on endoscopic resection of SSPs 10 mm or larger, through May 31st, 2019. The primary outcome was rate of residual SSP, which was the rate of residual SSP found at the polypectomy site during the first follow-up colonoscopy. Secondary outcomes were: technical success (rate of complete macroscopic resection), R0 resection rate (complete histological resection with absence of any polyp tissue at the lateral and deep margins after en-bloc resection), and adverse events (immediate or delayed bleeding and perforation). We performed IQR,group analyses for outcomes based on polyp size and resection techniques. Pooled proportion rates (%) or odds ratio with 95% CIs with heterogeneity (I2) and P < .05. RESULTS A total of 14 studies met the inclusion criteria: 911 patients (50.2% male; mean age, 62.8 ± 4.9 years) who underwent resection of 1137 SSPs (574 SSPs ≥ 20 mm) with a median polyp size of 19.4 mm (interquartile range, 15.9-29.6 mm). Follow-up information was available for 832 SSPs with a median follow-up duration of 12 months (interquartile range, 6-22.5 months). Piecemeal resection was performed in 58.5% SSPs. The pooled residual SSP rate was 4.3% (95% CI, 2%-6.5%). There was a higher residual SSP rate for polyps ≥ 20 mm compared to 10-19 mm (5.9% vs 1.2%; odds ratio, 3.02; 95% CI, 1-9.2; P = .049). Cold endoscopic mucosal resection (EMR) had significantly lower rates of delayed bleeding (0 vs 2.3%; P = .03) and residual polyp rate (0.9% vs 5%; P=.01) compared to hot EMR, based on univariate analysis. In multi-variate analysis there was no difference in residual polyp rate. There was no significant difference in other outcomes based on the size or method of resection. CONCLUSIONS In a systematic review and meta-analysis, we found that SSPs ≥ 10 mm can be safely resected with low residual polyp rates. Polyp size ≥ 20 mm is a significant factor for residual polyp. Compared to hot EMR, cold EMR is associated with a lower rate of delayed bleeding. Randomized controlled trials comparing hot and cold resection are needed to standardize techniques and optimize outcomes.
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Affiliation(s)
| | - Muhammad Aziz
- Department of Gastroenterology and Hepatology, University of Toledo, Toledo, Ohio
| | - Harsh K Patel
- Department of Gastroenterology and Hepatology, Ochsner Clinic Foundation, Jefferson, Louisiana
| | - Naaz Sidhu
- Westmead Hospital, University of Sydney Medical School, Sydney, Australia
| | - Abhiram Duvvuri
- Division of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas
| | - ChandraShekhar Dasari
- Department of Gastroenterology and Hepatology, Veteran Affairs Medical Center, Kansas City, Missouri
| | - Kevin F Kennedy
- Department of Gastroenterology and Hepatology, Veteran Affairs Medical Center, Kansas City, Missouri
| | - Ashwini Ashwath
- Department of Gastroenterology and Hepatology, Veteran Affairs Medical Center, Kansas City, Missouri
| | - Marco Spadaccini
- Department of Gastroenterology and Hepatology, Humanitas Clinical and Research Center, Humanitas University, Rozzano, Italy
| | - Madhav Desai
- Department of Gastroenterology and Hepatology, Veteran Affairs Medical Center, Kansas City, Missouri
| | - Ramprasad Jegadeesan
- Department of Gastroenterology and Hepatology, Southern Illinois University, Springfield, Illinois
| | - Anjana Sathyamurthy
- Department of Gastroenterology and Hepatology, Veteran Affairs Medical Center, Kansas City, Missouri
| | - Prashanth Vennalaganti
- Department of Gastroenterology and Hepatology, Veteran Affairs Medical Center, Kansas City, Missouri
| | - Divyanshoo Kohli
- Department of Gastroenterology and Hepatology, Veteran Affairs Medical Center, Kansas City, Missouri
| | - Cesare Hassan
- Department of Gastroenterology and Hepatology, Nuovo Regina Margherita Hospital, Digestive Endoscopy Unit, Rome, Italy
| | - Maria Pellise
- Department of Gastroenterology and Hepatology, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Alessandro Repici
- Department of Gastroenterology and Hepatology, Humanitas Clinical and Research Center, Humanitas University, Rozzano, Italy
| | - Prateek Sharma
- Department of Gastroenterology and Hepatology, Veteran Affairs Medical Center, Kansas City, Missouri
| | - Michael J Bourke
- Westmead Hospital, University of Sydney Medical School, Sydney, Australia
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Shichijo S, Takeuchi Y, Uedo N, Ishihara R. Management of local recurrence after endoscopic resection of neoplastic colonic polyps. World J Gastrointest Endosc 2018; 10:378-382. [PMID: 30631401 PMCID: PMC6323499 DOI: 10.4253/wjge.v10.i12.378] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/17/2018] [Accepted: 11/07/2018] [Indexed: 02/06/2023] Open
Abstract
A proportion of neoplastic polyps are incompletely resected, resulting in local recurrence, especially after resection of large polyps or piecemeal resection. Local recurrences that develop after endoscopic resection of intramucosal neoplasms that lacked risk factors for lymph node metastasis or positive vertical margins are usually treated endoscopically. Endoscopic submucosal dissection (ESD) is indicated for local residual or recurrent early carcinomas after endoscopic resection. However, ESD for such recurrent lesions is technically difficult and is typically a lengthy procedure. Underwater endoscopic mucosal resection (UEMR), which was developed in 2012, is suitable for recurrent or residual lesions and reportedly achieves superior en bloc resection rates and endoscopic complete resection rates than conventional EMR. However, a large recurrent lesion is a negative independent predictor of successful en bloc resection and of complete endoscopic removal. We therefore perform UEMR for relatively small (≤ 10-15 mm) recurrent lesions and ESD for larger lesions.
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Affiliation(s)
- Satoki Shichijo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka 541-8567, Chuo-ku, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka 541-8567, Chuo-ku, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka 541-8567, Chuo-ku, Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka 541-8567, Chuo-ku, Japan
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Ma MX, Bourke MJ. Sessile Serrated Adenomas: How to Detect, Characterize and Resect. Gut Liver 2018; 11:747-760. [PMID: 28494577 PMCID: PMC5669590 DOI: 10.5009/gnl16523] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 12/06/2016] [Indexed: 12/13/2022] Open
Abstract
Serrated polyps are important contributors to the burden of colorectal cancers (CRC). These lesions were once considered to have no malignant potential, but currently up to 30% of all CRC are recognized to arise from the serrated neoplasia pathway. The primary premalignant lesions are sessile serrated adenomas/polyps (SSA/Ps), although traditional serrated adenomas are relatively uncommon. Compared to conventional adenomas, SSA/Ps are morphologically subtle with indistinct borders, may be difficult to detect endoscopically, are more prevalent than previously thought, are associated with synchronous and metachronous advanced neoplasia, and have a higher risk of incomplete resection. Although many lesions remain “dormant,” progressive disease is associated with the development of dysplasia and more rapid progression to CRC. As a result, SSA/Ps are strongly implicated in the development of interval cancers. These factors represent unique challenges that require a meticulous approach to their management. In this review, we summarize the contemporary literature on the characterization, detection and resection of SSA/Ps.
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Affiliation(s)
- Michael X Ma
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
| | - Michael J Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia.,University of Sydney, Sydney, Australia
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Herreros de Tejada A, González-Lois C, Santiago J. Serrated lesions and serrated polyposis syndrome. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2017; 109:516-526. [PMID: 28530106 DOI: 10.17235/reed.2017.4065/2015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The serrated pathway has been shown to be an alternative colorectal carcinogenetic route potentially accounting for up to one third of all CRCs. Serrated lesions, particularly SSPs, have been a focus of research during the past few years. They have well-established histological and molecular characteristics that account for their potential carcinogenetic risk through the accumulation BRAF, KRAS and methylator profile (CpG) mutations. Their endoscopic identification and resection represent a challenge because of their specific characteristics, and the need for an adequate specimen for histological diagnosis. Knowledge of these lesions is key, as is the adoption of established criteria for their endoscopic description and histological diagnosis. SPS is the maximum expression of involvement by serrated lesions, is associated with increased risk for CRC, and requires attentive endoscopic follow-up, as well as family screening. While the exact etiopathogenic mechanism remains unknown, current research will likely provide us with appropriate answers in the not too distant future.
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Affiliation(s)
| | - Carmen González-Lois
- Anatomía Patológica, Hospital Universitario Puerta de Hierro Majadahonda, España
| | - José Santiago
- Digestivo, Hospital Universitario Puerta de Hierro Majadahonda, España
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Pellise M, Burgess NG, Tutticci N, Hourigan LF, Zanati SA, Brown GJ, Singh R, Williams SJ, Raftopoulos SC, Ormonde D, Moss A, Byth K, P'Ng H, Mahajan H, McLeod D, Bourke MJ. Endoscopic mucosal resection for large serrated lesions in comparison with adenomas: a prospective multicentre study of 2000 lesions. Gut 2017; 66:644-653. [PMID: 26786685 DOI: 10.1136/gutjnl-2015-310249] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 11/30/2015] [Accepted: 12/23/2015] [Indexed: 12/13/2022]
Abstract
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 ClinicalTrials.gov NCT01368289.
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Affiliation(s)
- Maria Pellise
- Departments of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Nicholas G Burgess
- Departments of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
- Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Nicholas Tutticci
- Departments of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Luke F Hourigan
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Department of Gastroenterology and Hepatology, Greenslopes Private Hospital, Brisbane, Queensland, Australia
| | - Simon A Zanati
- Department of Gastroenterology and Hepatology, The Alfred Hospital, Melbourne, Victoria, Australia
- Department of Gastroenterology and Hepatology, Western Hospital, Melbourne, Victoria, Australia
| | - Gregor J Brown
- Department of Gastroenterology and Hepatology, The Alfred Hospital, Melbourne, Victoria, Australia
- Department of Gastroenterology and Hepatology, Epworth Hospital, Melbourne, Victoria, Australia
| | - Rajvinder Singh
- Department of Gastroenterology and Hepatology, Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Stephen J Williams
- Departments of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Spiro C Raftopoulos
- Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Donald Ormonde
- Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Alan Moss
- Department of Gastroenterology and Hepatology, Western Hospital, Melbourne, Victoria, Australia
| | - Karen Byth
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
- Research and Education Network, Westmead Hospital, Sydney, New South Wales, Australia
| | - Heok P'Ng
- Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, New South Wales, Australia
| | - Hema Mahajan
- Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, New South Wales, Australia
| | - Duncan McLeod
- Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, New South Wales, Australia
| | - Michael J Bourke
- Departments of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
- Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
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Ashburn JH, Plesec TP, Kalady MF. Serrated Polyps and Serrated Polyposis Syndrome. Clin Colon Rectal Surg 2016; 29:336-344. [PMID: 31777465 DOI: 10.1055/s-0036-1584088] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Colorectal serrated polyps are intermediate lesions in the serrated neoplastic pathway, which account for up to 30% of colorectal cancers. This pathway is biologically distinct from the adenoma-to-carcinoma sequence, with associated cancers exhibiting mutations in the BRAF oncogene, DNA promoter hypermethylation, and microsatellite instability. An evolving understanding of these unique lesions has led to the development of a more accurate classification, improved endoscopic identification, and tailored clinical management guidelines. This article reviews serrated polyps and serrated polyposis syndrome.
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Affiliation(s)
- Jean H Ashburn
- Department of Colorectal Surgery, Sanford R. Weiss, MD, Center for Inherited Colorectal Neoplasia, Digestive Diseases Institute, Cleveland Clinic, Cleveland, Ohio
| | - Thomas P Plesec
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Matthew F Kalady
- Department of Colorectal Surgery, Sanford R. Weiss, MD, Center for Inherited Colorectal Neoplasia, Digestive Diseases Institute, Cleveland Clinic, Cleveland, Ohio
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Hassan C, Repici A, Sharma P, Correale L, Zullo A, Bretthauer M, Senore C, Spada C, Bellisario C, Bhandari P, Rex DK. Efficacy and safety of endoscopic resection of large colorectal polyps: a systematic review and meta-analysis. Gut 2016; 65:806-20. [PMID: 25681402 DOI: 10.1136/gutjnl-2014-308481] [Citation(s) in RCA: 266] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 01/20/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To assess the efficacy and safety of endoscopic resection of large colorectal polyps. DESIGN Relevant publications were identified in MEDLINE/EMBASE/Cochrane Central Register for the period 1966-2014. Studies in which ≥20 mm colorectal neoplastic lesions were treated with endoscopic resection were included. Rates of postendoscopic resection surgery due to non-curative resection or adverse events, as well as the rates of complete endoscopic removal, invasive cancer, adverse events, recurrence and mortality, were extracted. Study quality was ascertained according to Newcastle-Ottawa Scale. Forest plot was produced based on random effect models. I2 statistic was used to describe the variation across studies due to heterogeneity. Meta-regression analysis was also performed. RESULTS 50 studies including 6442 patients and 6779 large polyps were included in the analyses. Overall, 503 out of 6442 patients (pooled rate: 8%, 95% CI 7% to 10%, I2=78.6%) underwent surgery due to non-curative endoscopic resection, and 31/6442 (pooled rate: 1%, 95% CI 0.7% to 1.4%, I2=0%) to adverse events. Invasive cancer at histology, non-curative endoscopic resection, synchronous lesions and recurrence accounted for 58%, 28%, 2.2% and 5.9% of all the surgeries, respectively. Endoscopic perforation occurred in 96/6595 (1.5%, 95% CI 1.2% to 1.7%) polyps, while bleeding in 423/6474 (6.5%, 95% CI 5.9% to 7.1%). Overall, 5334 patients entered in surveillance, 502/5836 (8.6%, 95% CI 7.9% to 9.3%) being lost at follow-up. Endoscopic recurrence was detected in 735/5334 patients (13.8%, 95% CI 12.9% to 14.7%), being an invasive cancer in 14/5334 (0.3%, 95% CI 0.1% to 0.4%). Endoscopic treatment was successful in 664/735 cases (90.3%, 95% CI 88.2% to 92.5%). Mortality related with management of large polyps was reported in 5/6278 cases (0.08%, 95% CI 0.01% to 0.15%). CONCLUSIONS Endoscopic resection of large polyps appeared to be an extremely effective and safe intervention. However, an adequate endoscopic surveillance is necessary for its long-term efficacy.
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Affiliation(s)
- C Hassan
- Endoscopy Unit, 'Nuovo Regina Margherita Hospital', Rome, Italy
| | - A Repici
- Digestive Endoscopy Unit, Istituto Clinico Humanitas, Milan, Italy
| | - P Sharma
- Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Kansas, USA
| | | | - A Zullo
- Endoscopy Unit, 'Nuovo Regina Margherita Hospital', Rome, Italy
| | - M Bretthauer
- Department of Health Economy and Health Management, University of Oslo, Oslo, Norway Gastroenterology Unit, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - C Senore
- AOU S Giovanni Battista-CPO Piemonte, SCDO Epidemiologia dei Tumori 2, Turin, Italy
| | - C Spada
- Digestive Endoscopy Unit, Catholic University, Rome, Italy
| | | | - P Bhandari
- Division of Gastroenterology/Hepatology, Indiana University Medical Center, Indianapolis, Indiana, USA
| | - D K Rex
- Division of Gastroenterology/Hepatology, Indiana University Medical Center, Indianapolis, Indiana, USA
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Rex KD, Vemulapalli KC, Rex DK. Recurrence rates after EMR of large sessile serrated polyps. Gastrointest Endosc 2015; 82:538-41. [PMID: 25851161 DOI: 10.1016/j.gie.2015.01.025] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 01/08/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND Little is known regarding the recurrence rate after EMR of large (≥20 mm) sessile serrated adenoma/polyps (SSA/Ps). OBJECTIVE To compare the recurrence rate among SSA/Ps and conventional adenomas in patients referred to a specialty practice for EMR. DESIGN Retrospective cohort study. SETTING Academic hospital and a satellite surgery center. PATIENTS A total of 362 consecutive patients referred for resection of large (≥20 mm) polyps in the colorectum. INTERVENTIONS All EMRs were performed with a submucosal contrast agent. All subjects had a follow-up surveillance examination (inspection and biopsy of the EMR) at our center. MAIN OUTCOME MEASUREMENTS Rates of residual polyp at follow-up examination. RESULTS Residual polyp was identified among 8.7% of SSA/Ps compared with 11.1% for conventional adenomas (P = .8). LIMITATIONS Retrospective design, procedures performed by a single experienced endoscopist, low number of serrated lesions. CONCLUSIONS The rate of recurrence after EMR of SSA/Ps is similar to the rate after EMR of conventional adenomas.
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Affiliation(s)
- Kevin D Rex
- Division of Gastroenterology/Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Krishna C Vemulapalli
- Division of Gastroenterology/Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Douglas K Rex
- Division of Gastroenterology/Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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