PMID- 36306831
OWN - NLM
STAT- MEDLINE
DCOM- 20230223
LR  - 20230522
IS  - 1097-6779 (Electronic)
IS  - 0016-5107 (Linking)
VI  - 97
IP  - 3
DP  - 2023 Mar
TI  - Impact of margin thermal treatment after EMR of giant (>/=40 mm) colorectal lateral 
      spreading lesions.
PG  - 544-548
LID - S0016-5107(22)02085-5 [pii]
LID - 10.1016/j.gie.2022.10.032 [doi]
AB  - BACKGROUND AND AIMS: Increasing lesion size is a risk factor for recurrence after 
      piecemeal EMR (pEMR). Snare-tip soft coagulation (STSC) treatment of the 
      normal-appearing margin after pEMR of lesions >/= 20 mm has been shown to reduce 
      recurrence rates by 75% to 80%. We sought to evaluate the impact of STSC on giant 
      (>/= 40 mm) lateral spreading lesions treated by pEMR. We describe the relative 
      risk and absolute risks of recurrence with and without STSC margin treatment 
      after EMR of >/= 40-mm lesions. METHODS: We performed a retrospective evaluation of 
      a prospectively collected database on large lesions describing lesion size, 
      location, and methods of resection. We excluded lesions < 40 mm in maximum 
      dimension, those that did not undergo follow-up care at our center, and those in 
      which argon plasma coagulation was used for either ablative treatment of residual 
      polyp or margin treatment. Propensity score analysis was used to account for 
      potential differences between patients treated with and without STSC. RESULTS: 
      There were 68 lesions >/= 40 mm removed by pEMR without STSC treatment and 133 
      removed and treated with STSC. There were no differences between groups in 
      demographics, polyp size, location, histologic features, and mean follow-up time. 
      The recurrence rate in the no-treatment group was 35% versus 9% with STSC (P < 
      .00001 by direct comparison and P = .008 by using the propensity score analysis). 
      CONCLUSION: STSC treatment after pEMR of large lateral spreading lesions in the 
      colorectum reduced recurrences by 75%. However, the absolute recurrence rate of 
      9% remained clinically significant in the STSC-treated group. Short-term 
      follow-up care after STSC of lesions >/= 40 mm is still warranted, and additional 
      study of technical factors that eliminate recurrence after pEMR of giant lateral 
      spreading lesions is warranted.
CI  - Copyright (c) 2023 American Society for Gastrointestinal Endoscopy. Published by 
      Elsevier Inc. All rights reserved.
FAU - Nader, Setarah Mohammad
AU  - Nader SM
AD  - Indiana University School of Medicine, Indianapolis, Indiana, USA.
FAU - Lahr, Rachel E
AU  - Lahr RE
AD  - Division of Gastroenterology/Hepatology, Indiana University School of Medicine, 
      Indianapolis, Indiana, USA.
FAU - Rex, Douglas K
AU  - Rex DK
AD  - Division of Gastroenterology/Hepatology, Indiana University School of Medicine, 
      Indianapolis, Indiana, USA.
LA  - eng
PT  - Journal Article
DEP - 20221025
PL  - United States
TA  - Gastrointest Endosc
JT  - Gastrointestinal endoscopy
JID - 0010505
SB  - IM
MH  - Humans
MH  - Retrospective Studies
MH  - Colonoscopy/methods
MH  - Risk Factors
MH  - *Colorectal Neoplasms/pathology
MH  - Neoplasm Recurrence, Local/surgery
MH  - *Endoscopic Mucosal Resection/methods
MH  - Treatment Outcome
EDAT- 2022/10/29 06:00
MHDA- 2023/02/25 06:00
CRDT- 2022/10/28 19:23
PHST- 2022/07/29 00:00 [received]
PHST- 2022/09/16 00:00 [revised]
PHST- 2022/10/16 00:00 [accepted]
PHST- 2022/10/29 06:00 [pubmed]
PHST- 2023/02/25 06:00 [medline]
PHST- 2022/10/28 19:23 [entrez]
AID - S0016-5107(22)02085-5 [pii]
AID - 10.1016/j.gie.2022.10.032 [doi]
PST - ppublish
SO  - Gastrointest Endosc. 2023 Mar;97(3):544-548. doi: 10.1016/j.gie.2022.10.032. Epub 
      2022 Oct 25.