Surgical Endoscopy

, Volume 27, Issue 10, pp 3799–3805

Endoscopic mucosal resection in high- and low-volume centers: a prospective multicentric study

  • E. Masci
  • E. Viale
  • C. Notaristefano
  • B. Mangiavillano
  • G. Fiori
  • C. Crosta
  • M. Dinelli
  • M. Maino
  • P. Viaggi
  • F. Della Giustina
  • V. Teruzzi
  • G. Grasso
  • G. Manes
  • S. Zambelli
  • P. A. Testoni
Article

DOI: 10.1007/s00464-013-2977-5

Cite this article as:
Masci, E., Viale, E., Notaristefano, C. et al. Surg Endosc (2013) 27: 3799. doi:10.1007/s00464-013-2977-5

Abstract

Background

Endoscopic mucosal resection (EMR) is an effective therapeutic technique well-standardized worldwide for the treatment of gastrointestinal neoplasm limited to the mucosal layer. To date, no study has compared technical and clinical differences based on the number of EMRs performed per year. This study aimed to compare EMR technical success, complications, and clinical outcome between low-volume centers (LVCs) and high-volume centers (HVCs). A total of nine endoscopic centers were included in the study.

Methods

This prospective study investigated consecutive patients with sessile polyps or flat colorectal lesions 1 cm or larger referred for EMR.

Results

A total of 427 lesions were resected in 384 patients at nine endoscopic centers. Males accounted for 60.4 % and females for 39.6 % of the patients. Most of the EMRs (84.8 %) were performed in HVCs and only 15.2 % in LVCs. All the lesions were resected in only one session. Argon plasma coagulation was performed on the margins of piecemeal resection in 15.7 % of the patients in HVCs only. Complete excision was achieved for 98.6 % of the lesions in HVCs and 98.8 % of the lesions in LVCs. The complication rate was 4.4 % in HVCs and 4.6 % in LVCs (p = 0.94). Delayed bleeding occurred in 2.5 % of the HVC cases and 3.1 % of the LVC cases. Perforation occurred in 1.9 % of the HVC cases and 1.5 % of the LVC cases (p = 1.00). Recurrences were experienced with 15 % of the lesions: 15.5 % in HVCs and 14 % in LVCs (p = 0.79).

Conclusions

The study showed that EMR can be performed also in LVC.

Keywords

EMR Endoscopic mucosal resection High-volume centers Low-volume centers 

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • E. Masci
    • 1
  • E. Viale
    • 2
  • C. Notaristefano
    • 2
  • B. Mangiavillano
    • 1
  • G. Fiori
    • 3
  • C. Crosta
    • 3
  • M. Dinelli
    • 4
  • M. Maino
    • 4
  • P. Viaggi
    • 1
  • F. Della Giustina
    • 5
  • V. Teruzzi
    • 6
  • G. Grasso
    • 7
  • G. Manes
    • 8
  • S. Zambelli
    • 9
  • P. A. Testoni
    • 2
  1. 1.Gastrointestinal EndoscopyAzienda Ospedaliera San Paolo, University Hospital, University of MilanMilanItaly
  2. 2.Gastrointestinal EndoscopySan Raffaele HospitalMilanItaly
  3. 3.Gastrointestinal EndoscopyEuropean Institute of OncologyMilanItaly
  4. 4.Gastrointestinal EndoscopySan Gerardo HospitalMonzaItaly
  5. 5.Gastrointestinal EndoscopyMultimedica HospitalMilanItaly
  6. 6.Gastrointestinal EndoscopyValduce HospitalComoItaly
  7. 7.Gastrointestinal EndoscopyAngera HospitalAngeraItaly
  8. 8.Gastrointestinal EndoscopySacco HospitalMilanItaly
  9. 9.Gastrointestinal EndoscopyMaggiore HospitalCremaItaly

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