PMID- 33422686
OWN - NLM
STAT- MEDLINE
DCOM- 20220316
LR  - 20220316
IS  - 1542-7714 (Electronic)
IS  - 1542-3565 (Linking)
VI  - 20
IP  - 2
DP  - 2022 Feb
TI  - Outcomes of Deep Mural Injury After Endoscopic Resection: An International Cohort 
      of 3717 Large Non-Pedunculated Colorectal Polyps.
PG  - e139-e147
LID - S1542-3565(21)00009-4 [pii]
LID - 10.1016/j.cgh.2021.01.007 [doi]
AB  - BACKGROUND & AIMS: Although perforation is the most feared adverse event 
      associated with endoscopic mucosal resection (EMR), limited data exists 
      concerning its management. Therefore, we sought to evaluate the short- and 
      long-term outcomes of intra-procedural deep mural injury (DMI) in an 
      international multi-center observational cohort of large (>/=20 mm) 
      non-pedunculated colorectal polyps (LNPCPs). METHODS: Consecutive patients who 
      underwent EMR for a LNPCP >/=20 mm were evaluated. Significant DMI (S-DMI) was 
      defined as Sydney DMI Classification type III (muscularis propria injury, target 
      sign) or type IV/V (perforation without or with contamination, respectively). The 
      primary outcome was successful S-DMI defect closure. Secondary outcomes included 
      technical success (removal of all visible polypoid tissue during index EMR), 
      surgical referral and recurrence at first surveillance colonscopy (SC1). RESULTS: 
      Between July 2008 to May 2020, 3717 LNPCPs underwent EMR. Median lesion size was 
      35mm (interquartile range (IQR) 25 to 45mm). Significant DMI was identified in 
      101 cases (2.7%), with successful defect closure in 98 (97.0%) using a median of 
      4 through-the-scope clips (TTSCs; IQR 3 to 6 TTSCs). Three (3.0%) patients 
      underwent S-DMI-related urgent surgery. Technical success was achieved in 94 
      (93.1%) patients, with 46 (45.5%) admitted to hospital (median duration 1 day; 
      IQR 1 to 2 days). Comparing LNPCPs with and without S-DMI, no differences in 
      technical success (94 (93.1%) vs 3316 (91.7%); P = .62) or SC1 recurrence (12 
      (20.0%) vs 363 (13.6%); P = .15) were identified. CONCLUSIONS: Significant DMI is 
      readily managed endoscopically and does not appear to affect technical success or 
      recurrence.
CI  - Copyright (c) 2022 AGA Institute. Published by Elsevier Inc. All rights reserved.
FAU - Bar-Yishay, Iddo
AU  - Bar-Yishay I
AD  - Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, 
      Australia.
FAU - Shahidi, Neal
AU  - Shahidi N
AD  - Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, 
      Australia; Westmead Clinical School, University of Sydney, Sydney, Australia; 
      University of British Columbia, Department of Medicine, Vancouver, Canada.
FAU - Gupta, Sunil
AU  - Gupta S
AD  - Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, 
      Australia; Westmead Clinical School, University of Sydney, Sydney, Australia.
FAU - Vosko, Sergei
AU  - Vosko S
AD  - Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, 
      Australia.
FAU - van Hattem, W Arnout
AU  - van Hattem WA
AD  - Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, 
      Australia.
FAU - Schoeman, Scott
AU  - Schoeman S
AD  - Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, 
      Australia.
FAU - Sidhu, Mayenaaz
AU  - Sidhu M
AD  - Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, 
      Australia; Westmead Clinical School, University of Sydney, Sydney, Australia.
FAU - Tate, David J
AU  - Tate DJ
AD  - Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, 
      Australia; University Hospital of Ghent, Ghent, Belgium.
FAU - Hourigan, Luke F
AU  - Hourigan LF
AD  - Princess Alexandra Hospital, Department of Gastroenterology and Hepatology, 
      Brisbane, Australia; The University of Queensland and Greenslopes Private 
      Hospital, Gallipoli Medical Research Institute, School of Medicine, Brisbane, 
      Australia.
FAU - Singh, Rajvinder
AU  - Singh R
AD  - Lyell McEwan Hospital, Department of Gastroenterology and Hepatology, Adelaide, 
      Australia.
FAU - Moss, Alan
AU  - Moss A
AD  - Western Health, Department of Endoscopic Services, Melbourne, Australia.
FAU - Raftopoulos, Spiro C
AU  - Raftopoulos SC
AD  - Sir Charles Gairdner Hospital, Department of Gastroenterology and Hepatology, 
      Perth, Australia.
FAU - Brown, Gregor
AU  - Brown G
AD  - The Epworth Hospital, Department of Gastroenterology, Melbourne, Australia; The 
      Alfred Hospital, Department of Gastroenterology and Hepatology, Melbourne, 
      Australia.
FAU - Zanati, Simon
AU  - Zanati S
AD  - Western Health, Department of Endoscopic Services, Melbourne, Australia; The 
      Alfred Hospital, Department of Gastroenterology and Hepatology, Melbourne, 
      Australia.
FAU - Heitman, Steven J
AU  - Heitman SJ
AD  - University of Calgary, Cumming School of Medicine, Department of Medicine, 
      Calgary, Canada.
FAU - Lee, Eric Y T
AU  - Lee EYT
AD  - Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, 
      Australia; Westmead Clinical School, University of Sydney, Sydney, Australia.
FAU - Burgess, Nicholas
AU  - Burgess N
AD  - Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, 
      Australia; Westmead Clinical School, University of Sydney, Sydney, Australia.
FAU - Williams, Stephen J
AU  - Williams SJ
AD  - Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, 
      Australia; Westmead Clinical School, University of Sydney, Sydney, Australia.
FAU - Byth, Karen
AU  - Byth K
AD  - University of Sydney, National Health and Medical Research Council Clinical 
      Trials Centre, Sydney, Australia; Westmead Hospital, Western Sydney Local Health 
      District Research and Education Network, Sydney, Australia.
FAU - Bourke, Michael J
AU  - Bourke MJ
AD  - Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, 
      Australia; Westmead Clinical School, University of Sydney, Sydney, Australia. 
      Electronic address: michael@citywestgastro.com.au.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20210108
PL  - United States
TA  - Clin Gastroenterol Hepatol
JT  - Clinical gastroenterology and hepatology : the official clinical practice journal 
      of the American Gastroenterological Association
JID - 101160775
SB  - IM
CIN - Clin Gastroenterol Hepatol. 2022 Feb;20(2):e19-e21. PMID: 33609784
MH  - Cohort Studies
MH  - *Colonic Polyps/etiology/surgery
MH  - Colonoscopy/adverse effects
MH  - *Colorectal Neoplasms/etiology
MH  - *Endoscopic Mucosal Resection/adverse effects
MH  - Humans
OTO - NOTNLM
OT  - Adverse Event
OT  - Colonoscopy
OT  - Complication
OT  - Endoscopy
OT  - Perforation
EDAT- 2021/01/11 06:00
MHDA- 2022/03/17 06:00
CRDT- 2021/01/10 20:32
PHST- 2020/10/15 00:00 [received]
PHST- 2020/12/31 00:00 [revised]
PHST- 2021/01/05 00:00 [accepted]
PHST- 2021/01/11 06:00 [pubmed]
PHST- 2022/03/17 06:00 [medline]
PHST- 2021/01/10 20:32 [entrez]
AID - S1542-3565(21)00009-4 [pii]
AID - 10.1016/j.cgh.2021.01.007 [doi]
PST - ppublish
SO  - Clin Gastroenterol Hepatol. 2022 Feb;20(2):e139-e147. doi: 
      10.1016/j.cgh.2021.01.007. Epub 2021 Jan 8.