Endoscopic Mucosal Resection of Superficial Colorectal Neoplasms: Review of 140 Procedures

Abstract

Introduction and Aims: Endoscopic mucosal resection (EMR) has been shown to be useful in the removal of large colorectal sessile and flat lesions, avoiding the need for surgical resection. The aim of this study was to evaluate the efficacy and safety of EMR in colorectal lesions using the inject-and-cut technique.

Material and Methods: Based on the review of colonoscopy reports, performed from February 2007 and February 2010, resected lesions ≥ 10 mm in diameter were selected for the study. The endoscopic and histologic characteristics, complications, follow-up and surgical need were recorded.

Results: During the study period we performed 140 EMRs among 133 patients (82 men; mean age 64.4 ± 12.4 years). The majority of lesions were located proximal to the hepatic flexure (47.8%). Lesions mean size was 18.5 ± 8.5 mm. Morphologically lesions were classified as: Is-60; IIa-54; IIb-14; IIa+IIc-12. En-bloc resection was performed in 56.4% of cases. Lesions > 20mm in size were independently associated with a higher rate of piecemeal resection (OR: 13.7; 95% CI: 3.8-49.6; p < 0.0001) and residual lesion (OR: 7.3; 95% CI: 1.6-34.2; p = 0.012). A complete endoscopic clearance was achieved in 91.4% of cases. Histological classification: non-specific alterations-1; hyperplastic polyp-8; adenoma-124; adenocarcinoma-7. The complication rate was 5.7% (6 intra-procedural bleeding; 1 delayed bleeding; 1 perforation). Until now, 144 follow-up colonoscopies were performed in 90 patients. Local recurrence occurred in 17/90 (18.9%), 10 of whom were managed with a new EMR. The recurrence rate was not affected by the lesion’s dimension, location, and resection type. Twenty-one patients (15%) were referred for surgery, mainly because of incomplete resection of the index lesion.

Conclusion: EMR was effective and safe in the treatment of colorectal sessile and flat lesions. Lesions larger than 20mm were frequently associated with piecemeal resections, which did not lead to a higher recurrence rate. EMR is feasible for managing local recurrence.