PMID- 31887274
OWN - NLM
STAT- MEDLINE
DCOM- 20210217
LR  - 20210527
IS  - 1097-6779 (Electronic)
IS  - 0016-5107 (Linking)
VI  - 91
IP  - 5
DP  - 2020 May
TI  - Impact of en bloc resection on long-term outcomes after endoscopic mucosal 
      resection: a matched cohort study.
PG  - 1155-1163.e1
LID - S0016-5107(19)32567-2 [pii]
LID - 10.1016/j.gie.2019.12.025 [doi]
AB  - BACKGROUND AND AIMS: Residual or recurrent adenoma (RRA) is the major limitation 
      of piecemeal EMR (p-EMR) for large colonic laterally spreading lesions (LSLs) 
      >/=20 mm. En bloc EMR (e-EMR) has been shown to achieve low rates of RRA but 
      specific procedural and long-term outcomes are unknown. Our aim was to compare 
      long-term outcomes of size-matched LSLs stratified by whether they were resected 
      e-EMR or p-EMR. METHODS: Data from a prospective tertiary referral multicenter 
      cohort of large LSLs referred for EMR over a 10-year period were analyzed. 
      Outcomes were compared between sized-matched LSLs (20-25 mm) resected by p-EMR or 
      e-EMR. RESULTS: Five hundred seventy LSLs met the inclusion criteria of which 259 
      (45.4%) were resected by e-EMR. The risk of major deep mural injury (DMI) was 
      significantly higher in the e-EMR group (3.5% vs 1.0%, P = .05), whereas rates of 
      other intraprocedural adverse events did not differ significantly. Five of 9 
      (56%) LSLs, with endoscopic features of submucosal invasion (SMI), resected by 
      e-EMR were saved from surgery. RRA at first surveillance was lower in the e-EMR 
      group (2.0% vs 5.7%, P = .04), but this difference was negated at subsequent 
      surveillance. Rates of surgical referral were not significantly different between 
      the groups at either surveillance interval. CONCLUSION: When comparing e-EMR 
      against p-EMR for lesions </=25 mm in size of similar morphology in a large 
      prospective multicenter cohort, e-EMR offered no additional advantage for 
      predicted-benign LSLs. However, it was associated with an increased risk of major 
      DMI. Thus, en bloc resection techniques should be reserved for lesions suspicious 
      for invasive disease. (Clinical trial registration number: NCT01368289.).
CI  - Copyright (c) 2020. Published by Elsevier Inc.
FAU - Tate, David J
AU  - Tate DJ
AD  - Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New 
      South Wales, Australia; Westmead Clinical School, The University of Sydney, 
      Sydney, New South Wales, Australia; Department of Gastroenterology and 
      Hepatology, University Hospital of Gent, Gent, Belgium.
FAU - Sidhu, Mayenaaz
AU  - Sidhu M
AD  - Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New 
      South Wales, Australia; Westmead Clinical School, The University of Sydney, 
      Sydney, New South Wales, Australia.
FAU - Bar-Yishay, Iddo
AU  - Bar-Yishay I
AD  - Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New 
      South Wales, Australia.
FAU - Desomer, Lobke
AU  - Desomer L
AD  - Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New 
      South Wales, Australia.
FAU - Brown, Gregor
AU  - Brown G
AD  - Department of Gastroenterology and Hepatology, The Alfred Hospital, Melbourne, 
      Victoria, Australia; Department of Gastroenterology and Hepatology, Epworth 
      Hospital, Melbourne, Victoria, Australia.
FAU - Hourigan, Luke F
AU  - Hourigan LF
AD  - Department of Gastroenterology and Hepatology, Greenslopes Private Hospital, 
      Brisbane, Queensland, Australia; Gallipoli Medical Research Institute, School of 
      Medicine, The University of Queensland, Greenslopes Private Hospital, Brisbane, 
      Queensland, Australia.
FAU - Lee, Eric Y T
AU  - Lee EYT
AD  - Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New 
      South Wales, Australia.
FAU - Moss, Alan
AU  - Moss A
AD  - Department of Gastroenterology and Hepatology, Footscray Hospital, Melbourne, 
      Victoria, Australia; Department of Medicine, Melbourne Medical School, The 
      University of Melbourne, Melbourne, Victoria, Australia.
FAU - Raftopoulos, Spiro
AU  - Raftopoulos S
AD  - Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, 
      Perth, Western Australia, Australia.
FAU - Singh, Rajvinder
AU  - Singh R
AD  - Department of Gastroenterology and Hepatology, Lyell McEwan Hospital, Adelaide, 
      South Australia, Australia.
FAU - Williams, Stephen J
AU  - Williams SJ
AD  - Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New 
      South Wales, Australia.
FAU - Zanati, Simon
AU  - Zanati S
AD  - Department of Gastroenterology and Hepatology, The Alfred Hospital, Melbourne, 
      Victoria, Australia; Department of Gastroenterology and Hepatology, Footscray 
      Hospital, Melbourne, Victoria, Australia.
FAU - Burgess, Nicholas
AU  - Burgess N
AD  - Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New 
      South Wales, Australia; Westmead Clinical School, The University of Sydney, 
      Sydney, New South Wales, Australia.
FAU - Bourke, Michael J
AU  - Bourke MJ
AD  - Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New 
      South Wales, Australia; Westmead Clinical School, The University of Sydney, 
      Sydney, New South Wales, Australia.
LA  - eng
SI  - ClinicalTrials.gov/NCT01368289
PT  - Clinical Trial
PT  - Journal Article
PT  - Multicenter Study
DEP - 20191228
PL  - United States
TA  - Gastrointest Endosc
JT  - Gastrointestinal endoscopy
JID - 0010505
SB  - IM
CIN - Gastrointest Endosc. 2020 Dec;92(6):1276-1277. PMID: 33237001
CIN - Gastrointest Endosc. 2020 Dec;92(6):1277-1278. PMID: 33237003
CIN - Gastrointest Endosc. 2021 Jan;93(1):280-281. PMID: 33353632
CIN - Gastrointest Endosc. 2021 Jan;93(1):281-282. PMID: 33353633
MH  - Adenoma/surgery
MH  - Cohort Studies
MH  - Colonoscopy
MH  - *Endoscopic Mucosal Resection
MH  - Humans
MH  - Intestinal Mucosa/surgery
MH  - Prospective Studies
MH  - Treatment Outcome
EDAT- 2019/12/31 06:00
MHDA- 2021/02/18 06:00
CRDT- 2019/12/31 06:00
PHST- 2019/09/25 00:00 [received]
PHST- 2019/12/10 00:00 [accepted]
PHST- 2019/12/31 06:00 [pubmed]
PHST- 2021/02/18 06:00 [medline]
PHST- 2019/12/31 06:00 [entrez]
AID - S0016-5107(19)32567-2 [pii]
AID - 10.1016/j.gie.2019.12.025 [doi]
PST - ppublish
SO  - Gastrointest Endosc. 2020 May;91(5):1155-1163.e1. doi: 10.1016/j.gie.2019.12.025. 
      Epub 2019 Dec 28.