Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jul 16, 2020; 12(7): 198-211
Published online Jul 16, 2020. doi: 10.4253/wjge.v12.i7.198
Colon mucosal neoplasia referred for endoscopic mucosal resection: Recurrence of adenomas and prediction of submucosal invasion
Mamoon Ur Rashid, Neelam Khetpal, Hammad Zafar, Saeed Ali, Evgeny Idrisov, Yuan Du, Assaf Stein, Deepanshu Jain, Muhammad Khalid Hasan
Mamoon Ur Rashid, Neelam Khetpal, Hammad Zafar, Yuan Du, Department of Internal Medicine, Advent Health Graduate Medical Education, Orlando, FL 32804, United States
Saeed Ali, Department of Internal Medicine, Univerity of Iowa hospital, Iowa City, IA 52242, United States
Evgeny Idrisov, Department of Gastroenterology, University of Oklahoma Health Sciences, Oklahoma, OK 73104, United States
Assaf Stein, Deepanshu Jain, Muhammad Khalid Hasan, Center for Interventional Endoscopy, AdventHealth, Orlando, FL 32803, United States
Author contributions: Rashid MU, Khetpal N, Zafar H, Ali S, Idrisov E and Du Y was involved in conceptualization, writing-original draft, software and visualization; Ali S, Idrisov E and Du Y was involved in data curation, formal analysis, investigation, methodology; Stein A, Jain D and Hasan MK performed writing review and editing; all authors have read and approve the final manuscript.
Institutional review board statement: The study was reviewed and approved for publication by our institutional reviewer.
Informed consent statement: As it is a retrospective study and data was reviewed retrospectively from chart review so patient’s consents are not needed.
Conflict-of-interest statement: All the Authors except Dr. Hasan have no conflict of interest related to the manuscript Dr. Hasan is consultant for Olympus America and Boston Scientific Corporation.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Mamoon Ur Rashid, MBBS, MD, Doctor, Medical Resident, Department of Internal Medicine, Advent Health Graduate Medical Education, 2501 North Orange Avenue, Orlando, FL 32804, United States. mamoon.rashid.md@adventhealth.com
Received: March 10, 2020
Peer-review started: March 10, 2020
First decision: April 2, 2020
Revised: May 28, 2020
Accepted: June 10, 2020
Article in press: June 10, 2020
Published online: July 16, 2020
ARTICLE HIGHLIGHTS
Research background

Endoscopic techniques including endoscopic mucosal resection (EMR) and endoscopic submucosal dissection are two minimally invasive techniques for removing large colonic lesions. We did a retrospective study to evaluate the effectiveness of endoscopic mucosal resection for removal of large colon mucosal lesions. We also studied in detail the various endoscopic features predicting submucosal invasion and recurrence of lesions.

Research motivation

Endoscopic techniques including EMR has been increasing used in resecting large colon lesions. Our research signifies the effectiveness of EMR technique as well as describes pathology, size, location, Kudo Pit classification and Paris Classification of lesions.

Research objectives

Our main objective was to determine the recurrence rate of adenomas after resection and endoscopic features that may predict submucosal invasion of colonic mucosal neoplasia. This will help the clinicians to identify the advanced colon lesions and will guide management accordingly.

Research methods

Our research is a retrospective study involving detailed chart review. This is one of the largest studies conducted in Central Florida as our institution serve as tertiary care referral center. The study span was nearly 3 years.

Research results

We analyzed the charts of 480 patients. The median age in our study was 68 (IQR: 14) with 52% males. The most common lesion location was ascending colon (161; 32%). Paris classification 0-IIa (Flat elevation of mucosa - 316; 63.2%); Kudo Pit Pattern IIIs (192; 38%) and Granular surface morphology (260; 52%) were most prevalent. Submucosal invasion was present in 23 (4.6%) out of 500 lesions. The independent risk factors for submucosal invasive lesion were Kudo Pit Pattern IIIL+IV and V (Odds ratio: 4.5; P value < 0.004) and Paris classification 0-IIc (Odds ratio: 18.2; P value < 0.01). Out of 500, 354 post-EMR scars were examined at surveillance colonoscopy. Recurrence was noted in 21.8% (77 cases).

Research conclusions

We found that size of lesion was an important variable for recurrence of colon lesion. Our research showed few high-risk endoscopic features for submucosal invasion (Kudo Pit Pattern IIIL + IV and V and Paris classification 0-IIc). Our study results have been in accordance with the previous research studies as well. We can hypothesize from this research that lesion size and endoscopic features can help in identification of lesions with higher risk for recurrence and submucosal invasion. These findings will help the clinicians in early identification of these lesions and help them in further management.

Research perspectives

Future research studies are needed to determine if recurrence rate of adenomas can be decreased by endoscopic techniques including wide filed EMR and snare tip soft coagulation of resection margins after adenoma resection.