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Underwater endoscopic mucosal resection for recurrences after previous piecemeal resection of colorectal polyps (with video).

Abstract：

BACKGROUND:Conventional endoscopic treatment of a recurrent adenoma after piecemeal EMR (PEMR) of a colorectal laterally spreading tumor (LST) is technically difficult with low en bloc resection rates because of the inability to snare fibrotic residual. OBJECTIVE:To assess the feasibility of salvage underwater EMR (UEMR) for the treatment of recurrent adenoma after PEMR of a colorectal LST. DESIGN:Retrospective, cross-sectional study. SETTING:Single, tertiary-care referral center. PATIENTS:Patients who have recurrent adenoma after PEMR of colorectal LST (≥2 cm). INTERVENTIONS:UEMR versus EMR. MAIN OUTCOME MEASUREMENT:En bloc resection rate, endoscopic complete removal rate, recurrence rate on follow-up colonoscopy, adjunctive ablation rate with argon plasma coagulation (APC) during salvage procedure, and independent predictive factors for successful en bloc resection and endoscopic complete removal. RESULTS:Eighty salvage procedures (36 UEMRs vs 44 EMRs) were analyzed. En bloc resection rate (47.2% vs 15.9%, P = .002) and endoscopic complete removal rate (88.9% vs 31.8%, P < .001) were higher in the UEMR group than in the EMR group. APC ablation of visible residual during salvage procedure was lower in UEMR group than EMR group (11.1% vs 65.9%, P < .001). Recurrence rate on follow-up colonoscopy was significantly lower in the UEMR group than the EMR group (10% vs 39.4%, P = .02). UEMR was an independent predictor of successful en bloc resection and endoscopic complete removal. LIMITATIONS:Retrospective, single-center study. CONCLUSIONS:UEMR can be a useful and feasible technique as a salvage procedure for recurrent colorectal adenoma after PEMR.

journal_name

Gastrointest Endosc

journal_title

Gastrointestinal endoscopy

authors

Kim HG,Thosani N,Banerjee S,Chen A,Friedland S

doi

10.1016/j.gie.2014.05.318

subject

Has Abstract

pub_date

2014-12-01 00:00:00

pages

1094-102

issue

6

eissn

0016-5107

issn

1097-6779

pii

S0016-5107(14)01808-2

journal_volume

80

pub_type

杂志文章

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