Skip to main content

Advertisement

SpringerLink
Log in

En bloc endoscopic mucosal resection is equally effective for sessile serrated polyps and conventional adenomas

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Sessile serrated polyps (SSPs) are associated with higher rates of incomplete resection compared to conventional adenomas after traditional snare polypectomy. Outcomes after endoscopic mucosal resection (EMR) are less established. The aim of this study was to evaluate the rate of residual neoplasia at surveillance colonoscopy for SSPs compared to conventional adenomas ≥ 10 mm after en bloc EMR.

Methods

Retrospective cohort study of consecutive patients referred for EMR of a colonic lesion ≥ 10 mm from 2005 to 2013. Data on procedures, histopathology, and surveillance colonoscopies were recorded. The primary outcome was rate of macroscopically evident residual neoplasia at surveillance colonoscopy for SSPs compared to adenomas. Secondary outcomes included rate of neoplasia at the resection margin.

Results

283 consecutive patients with 293 polyps underwent en bloc EMR including 101 SSPs and 192 adenomas. Pathology commented on the lateral resection margins of the specimen in 235 cases (80%). Of these, neoplasia was noted at the resection margin in 29/64 SSPs (45.3%) compared to 65/171 adenomas (38.0%; P = .37). Surveillance data were available for 153 index lesions with a median interval of 13 months (interquartile range, 10.75–23.25 months). Ten resection sites (6.5%) were found to have residual neoplasia, including 2/52 SSPs (3.8%) and 8/101 adenomas (7.9%; P = .50). Of the cases with surveillance data 128/153 (84%) commented on the lateral margin of the resection specimen. Residual neoplasia was noted in 3/68 lesions (4.4%) with negative margins compared to 5/60 lesions (8.3%) with positive margins (P = .47).

Conclusions

En bloc EMR for colonic lesions ≥ 10 mm is associated with a 6.5% rate of macroscopic residual neoplasia. Although 45% of SSPs had neoplasia extending to the resection margin, rates of residual neoplasia at surveillance colonoscopy were low. These results suggest that when feasible en bloc EMR is a reasonable option to resect SSPs ≥ 10 mm.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

SSP:

Sessile serrated adenoma/polyp

IRR:

Incomplete resection rate

CRC:

Colorectal cancer

EMR:

Endoscopic mucosal resection

IBD:

Inflammatory bowel disease

APC:

Argon plasma coagulation

TSA:

Traditional serrated adenomas

References

  1. Buchner AM, Guarner-Argente C, Ginsberg GG (2012) Outcomes of EMR of defiant colorectal lesions directed to an endoscopy referral center. Gastrointest Endosc 76:255–263

    Article  PubMed  Google Scholar 

  2. Elta GH (2012) What is a defiant polyp and how good are we at removing them? Gastrointest Endosc 76:264–266

    Article  PubMed  Google Scholar 

  3. Pohl H, Srivastava A, Bensen SP et al (2013) Incomplete polyp resection during colonoscopy-results of the complete adenoma resection (CARE) study. Gastroenterology 144:74–80

    Article  PubMed  Google Scholar 

  4. Chandrasekhara V, Ginsberg GG (2011) Endoscopic mucosal resection: not your father’s polypectomy anymore. Gastroenterology 141:42–49

    Article  PubMed  Google Scholar 

  5. Pellise M, Burgess NG, Tutticci N et al (2017) Endoscopic mucosal resection for large serrated lesions in comparison with adenomas: a prospective multicentre study of 2000 lesions. Gut 66:644–653

    Article  PubMed  Google Scholar 

  6. Moss A, Bourke MJ, Williams SJ et al (2011) Endoscopic mucosal resection outcomes and prediction of submucosal cancer from advanced colonic mucosal neoplasia. Gastroenterology 140:1909–1918

    Article  PubMed  Google Scholar 

  7. Belderbos TD, Leenders M, Moons LM et al (2014) Local recurrence after endoscopic mucosal resection of nonpedunculated colorectal lesions: systematic review and meta-analysis. Endoscopy 46:388–402

    Article  PubMed  Google Scholar 

  8. Ahlenstiel G, Hourigan LF, Brown G et al (2014) Actual endoscopic versus predicted surgical mortality for treatment of advanced mucosal neoplasia of the colon. Gastrointest Endosc 80:668–676

    Article  PubMed  Google Scholar 

  9. Law R, Das A, Gregory D et al (2016) Endoscopic resection is cost-effective compared with laparoscopic resection in the management of complex colon polyps: an economic analysis. Gastrointest Endosc 83:1248–1257

    Article  PubMed  Google Scholar 

  10. Jayanna M, Burgess NG, Singh R et al (2016) Cost analysis of endoscopic mucosal resection vs surgery for large laterally spreading colorectal lesions. Clin Gastroenterol Hepatol 14:271–278

    Article  PubMed  Google Scholar 

  11. Rex KD, Vemulapalli KC, Rex DK (2015) Recurrence rates after EMR of large sessile serrated polyps. Gastrointest Endosc 82:538–541

    Article  PubMed  Google Scholar 

  12. Moss A, Williams SJ, Hourigan LF et al (2015) Long-term adenoma recurrence following wide-field endoscopic mucosal resection (WF-EMR) for advanced colonic mucosal neoplasia is infrequent: results and risk factors in 1000 cases from the Australian Colonic EMR (ACE) study. Gut 64:57–65

    Article  PubMed  Google Scholar 

  13. Rao AK, Soetikno R, Raju GS et al (2016) Large sessile serrated polyps can be safely and effectively removed by endoscopic mucosal resection. Clin Gastroenterol Hepatol 14:568–574

    Article  PubMed  Google Scholar 

  14. Boland CR, Goel A (2010) Microsatellite instability in colorectal cancer. Gastroenterology 138:2073–2087

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Eichenseer PJ, Dhanekula R, Jakate S et al (2013) Endoscopic mis-sizing of polyps changes colorectal cancer surveillance recommendations. Dis Colon Rectum 56:315–321

    Article  PubMed  Google Scholar 

  16. Burgess NG, Tutticci NJ, Pellise M et al (2014) Sessile serrated adenomas/polyps with cytologic dysplasia: a triple threat for interval cancer. Gastrointest Endosc 80:307–310

    Article  PubMed  Google Scholar 

  17. Thibodeau SN, Bren G, Schaid D (1993) Microsatellite instability in cancer of the proximal colon. Science 260:816–819

    Article  CAS  PubMed  Google Scholar 

  18. Limketkai BN, Lam-Himlin D, Arnold MA et al (2013) The cutting edge of serrated polyps: a practical guide to approaching and managing serrated colon polyps. Gastrointest Endosc 77:360–375

    Article  PubMed  Google Scholar 

  19. Lieberman DA, Rex DK, Winawer SJ et al (2012) Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society adenomask Force on Colorectal Cancer. Gastroenterology 143:844–857

    Article  PubMed  Google Scholar 

  20. Rex DK, Ahnen DJ, Baron JA et al (2012) Serrated lesions of the colorectum: review and recommendations from an expert panel. Am J Gastroenterol 107:1315–1329

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Boulevard, South Pavilion, 4th Floor, Philadelphia, PA, 19104, USA

    Amol Agarwal, Sidyarth Garimall, Frank I. Scott, Nuzhat A. Ahmad, Michael L. Kochman, Gregory G. Ginsberg & Vinay Chandrasekhara

Authors
  1. Amol Agarwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sidyarth Garimall
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Frank I. Scott
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nuzhat A. Ahmad
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael L. Kochman
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gregory G. Ginsberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Vinay Chandrasekhara
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

AA—study conception and design, Institutional Review Board approval, data collection, manuscript drafting and editing; SG—data collection; FIS—statistical analysis; NAA—critical review of manuscript for intellectual content; MLK—critical review of manuscript for intellectual content; GGG—critical review of manuscript for intellectual content; VC—study conception and design, manuscript drafting, critical review of manuscript for intellectual content

Corresponding author

Correspondence to Vinay Chandrasekhara.

Ethics declarations

Disclosures

Dr. Ahmad reports that her spouse is employed with AstraZeneca and Dr. Ahmad receives stock from Bristol-Myers Squibb. Dr. Kochman reports that his spouse is employed at Merck, and he serves as a consultant with Boston Scientific and Dark Canyon Laboratory. Dr. Ginsberg serves as a consultant for Olympus Inc, Boston Scientific, Microinterventional Devices, and Fractyl. Dr. Chandrasekhara serves as a consultant for Boston Scientific. Dr. Amol Agarwal, Sidyarth Garimall, and Dr. Scott have no conflicts of interest or financial ties to disclose

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Agarwal, A., Garimall, S., Scott, F.I. et al. En bloc endoscopic mucosal resection is equally effective for sessile serrated polyps and conventional adenomas. Surg Endosc 32, 1871–1878 (2018). https://doi.org/10.1007/s00464-017-5876-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-017-5876-3

Keywords

Search

Navigation