Risk factors for local residual neoplasia after endoscopic mucosal resection

Czech version

Authors: N. Brogyuk ¹; T. Grega ¹; M. Voška ¹; O. Ngo ²; O. Májek ²; L. Dušek ²; M. Zavoral ¹; Š. Suchánek ¹
Authors‘ workplace: Interní klinika 1. LF UK a ÚVN – VFN Praha ¹; Institut biostatistiky a analýz, LF MU, Brno ²
Published in: Gastroent Hepatol 2017; 71(5): 394-400
Category: Gastrointestinal Oncology: Original Article
doi: https://doi.org/10.14735/amgh2017394

Overview

Introduction:
Endoscopic mucosal resection (EMR) is considered an effective endoscopic treatment of sessile polyps and non-polypoid colorectal neoplasia. A limitation of this technique is the risk of incomplete endoscopic resection, which can lead to local residual neoplasia development.

Aim:
Identification of the risk factors associated with local residual neoplasia (LRN) onset.

Methods:
Retrospective analysis was performed on colorectal neoplasia EMRs in one high-volume tertiary-referral endoscopic center in 2013–2015. Individuals with at least one follow-up colonoscopy after the initial EMR were included. LRN was defined as the histopathological presence of neoplastic tissue at the post-EMR site. Univariate and multivariate analysis of factors associated with LRN were performed.

Results:
280 EMRs of sessile polyps and non-polypoid colorectal neoplasia (size ≥ 10 mm) including laterally spreading tumors (LST) were analyzed and surveillance endoscopy was carried out on 186 lesions (66.4% of all EMRs) in 163 patients (66.3% male; mean age 67 years). The mean follow-up interval was 7.8 months. LRN was verified in 33 lesions (17.7%) resected by EMR. Single variate analysis showed evidence of an increased risk of residual neoplasia for lesions ≥ 20 mm (p = 0.006), LST with granular type (p = 0.002), villous component of adenomas with low grade dysplasia (p < 0.001), and with high grade dysplasia (p = 0.005), and piece meal EMR (p = 0.006). In multivariate analysis, there were no statistically significant factors associated with LRN.

Conclusion:
The risk factors for local residual neoplasia include lesion size ≥ 20 mm, villous component of adenomas, piece meal EMR technique, and LST lesions of the granular type. In these cases, earlier endoscopic post-EMR surveillance or alternative endoscopic or surgical techniques should be considered.

Key words:
endoscopic mucosal resection – local residual neoplasia – risk factors – laterally spreading tumor

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Submitted:
20.9.2017

Accepted:
27.9.2017

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