Outcome of EMR as an alternative to surgery in patients with complex colon polyps

• Published in: Gastrointestinal endoscopy Vol. 84; no. 2; pp. 315 - 325
• Main Authors: Raju, Gottumukkala S., MD, FASGE, Lum, Phillip J., MS, Ross, William A., MD, MBA, FASGE, Thirumurthi, Selvi, MD, Miller, Ethan, MD, Lynch, Patrick M., MD, Lee, Jeffrey H., MD, MPH, FASGE, Bhutani, Manoop S., MD, FASGE, Shafi, Mehnaz A., MD, Weston, Brian R., MD, Pande, Mala, MBBS, MPH, PhD, Bresalier, Robert S., MD, Rashid, Asif, MD, PhD, Mishra, Lopa, MD, Davila, Marta L., MD, FASGE, Stroehlein, John R., MD, FASGE
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2016
• Subjects: Adenoma - pathology; Adenoma - surgery; Adult; Aged; Aged, 80 and over; Colectomy; Colonic Polyps - pathology; Colonic Polyps - surgery; Colonoscopy - methods; Colorectal Neoplasms - pathology; Colorectal Neoplasms - surgery; Endoscopic Mucosal Resection - methods; Female; Gastroenterology and Hepatology; Humans; Male; Middle Aged; Neoplasm, Residual; Postoperative Complications - epidemiology; Retrospective Studies
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2016.01.067

Background and Aims Patients with complex colon polyps were traditionally referred for surgery to avoid adverse events associated with endoscopic resection. Recent advances in endoscopic imaging as well endoscopic hemostasis and clip closure allow for the use of EMR as an alternative to surgery for such lesions. To determine the outcome of treatment of complex colon polyps with EMR as an alternative to surgery, we conducted a retrospective observational study. Methods Two hundred three patients with complex colon polyps were referred to an EMR center as an alternative to surgery. Patients underwent a protocol-driven EMR. The primary endpoint was the complete resection rate. Secondary endpoints were safety, residual adenoma rate, and incidence of missed synchronous polyps. Results EMR was performed in 155 patients and was deferred in 48 patients who were referred to surgery. EMR specimens revealed benign polyps in 149 and cancer in 6 patients. EMR adverse events occurred in 7 patients, requiring hospitalization in 5 of them. None of the patients died as a result of their adverse events. Surveillance colonoscopy at 4 to 6 months after resection of a benign lesion in 137 patients revealed residual adenoma at the scar site in 6 patients and additional synchronous precancerous lesions in 117 patients that were not removed by the referring endoscopist. None underwent surgery for failure of EMR. The overall precancerous lesion burden was 2.83 per patient, the adenoma burden was 2.13 per patient, and the serrated polyp burden was .69 per patient. Conclusions EMR can be used instead of surgery for complex colon polyps in 75% of patients with few adverse events and few residual adenomas at resection sites. In addition, careful repeat examination of the entire colon for synchronous lesions overlooked by the referring endoscopist is required for most patients. (Clinical trial registration number: NCT01827241 .)