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Complication and local recurrence rate after endoscopic resection of large high-risk colorectal adenomas of ≥3 cm in size

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Endoscopic resection is a widely used technique for treatment of large colorectal adenomas, but few data are available including only lesions larger than ≥2 cm. The aim of this study is to evaluate the complication and recurrence rate after endoscopic resection of high-risk colorectal adenomas ≥3 cm in size.

Methods

Retrospective analysis of a prospectively maintained database of patients undergoing polypectomy of large colorectal polyps of ≥3 cm.

Results

In 341 patients, 360 colorectal adenomas with a mean size of 3.9 cm were resected endoscopically. In 25 patients, a complication including 22 delayed bleedings (6.5 %) and three perforations (0.9 %) occurred. Single-variate analysis showed an increasing risk of complications for larger adenomas (3.9 vs. 4.6 cm; p ≤ 0.05). Two hundred twelve patients with 224 adenomas had undergone at least one documented follow-up endoscopy with a medium follow-up period of 16 months. In 95 resected lesions (42.4 %), a residual adenoma occurred in the first follow-up colonoscopy (n = 88, 92.6 %) or a recurrent adenoma occurred after at least one negative follow-up colonoscopy (n = 7, 7.4 %). In multivariate analysis, risk factors were lesion size, sessile growth pattern, and the performing endoscopist. The complication and recurrence rate correlated inversely between endoscopists.

Conclusions

The present study is the largest study showing complication and recurrence rates after colorectal polypectomy of advanced colorectal adenomas of ≥3 cm in size. Polyp size was identified as the most important risk factor for complications. For the first time, this study shows that the complication rate after colorectal polypectomy of large adenomas is correlated inversely with the residual and/or recurrence rate.

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References

  1. Winawer SJ, Fletcher RH, Miller L, Godlee F, Stolar MH, Mulrow CD et al (1997) Colorectal cancer screening: clinical guidelines and rationale. Gastroenterology 112:594–642

    Article  CAS  PubMed  Google Scholar 

  2. Kaminski MF, Regula J, Kraszewska E, Polkowski M, Wojciechowska U et al (2010) Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med 362:1795–1803

    Article  CAS  PubMed  Google Scholar 

  3. Corley DA, Jensen CD, Marks AR, Zhao WK, Lee JK et al (2014) Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med 370:1298–1306

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Løberg M, Kalager M, Holme Ø, Hoff G, Adami HO, Bretthauer M (2014) Long-term colorectal-cancer mortality after adenoma removal. N Engl J Med 371:799–807

    Article  PubMed  Google Scholar 

  5. Heldwein W, Dollhopf M, Rösch T, Meining A, Schmidtsdorff G, Hasford J, Hermanek P, Burlefinger R, Birkner B, Schmitt W (2005) Munich Gastroenterology Group. The Munich Polypectomy Study (MUPS): prospective analysis of complications and risk factors in 4000 colonic snare polypectomies. Endoscopy 37(11):1116–1122

    Article  CAS  PubMed  Google Scholar 

  6. Moss A, Bourke MJ, Williams SJ, Hourigan LF, Brown G, Tam W, Singh R, Zanati S, Chen RY, Byth K (2014) Endoscopic mucosal resection outcomes and prediction of submucosal cancer from advanced colonic mucosal neoplasia. Gastroenterology 140(7):1909–1918

    Article  Google Scholar 

  7. Maguire LH, Shellito PC (2014) Endoscopic piecemeal resection of large colorectal polyps with long-term follow up. Surg Endosc 28(9):2641–2648

    Article  PubMed  Google Scholar 

  8. Pohl H, Srivastava A, Bensen SP, Anderson P, Rothstein RI, Gordon SR, Levy LC, Toor A, Mackenzie TA, Rosch T, Robertson DJ (2013) Incomplete polyp resection during colonoscopy-results of the complete adenoma resection (CARE) study. Gastroenterology 144(1):74–80

    Article  PubMed  Google Scholar 

  9. Moss A, Williams SJ, Hourigan LF, Brown G, Tam W, Singh R, Zanati S, Burgess NG, Sonson R, Byth K, Bourke MJ (2015) Long-term adenoma recurrence following wide-field endoscopic mucosal resection (WF-EMR) for advanced colonic mucosal neoplasia is infrequent: results and risk factors in 1000 cases from the Australian Colonic EMR (ACE) study. Gut 64(1):57–65

    Article  PubMed  Google Scholar 

  10. Belderbos TDG, Leenders M, Moons LMG, Siersema PD (2014) Local recurrence after endoscopic mucosal resection of nonpedunculated colorectal lesions: systematic review and meta-analysis. Endoscopy 46:388–400

    Article  PubMed  Google Scholar 

  11. Wang J, Zhang XH, Ge J, Yang CM, Liu JY, Zhao SL (2014) Endoscopic submucosal dissection vs endoscopic mucosal resection for colorectal tumors: a meta-analysis. World J Gastroenterol 20(25):8282–8287

    Article  PubMed  PubMed Central  Google Scholar 

  12. Oka S, Tanaka S, Saito Y, Iishi H, Kudo SE, Ikematsu H, Igarashi M, Saitoh Y, Inoue Y, Kobayashi K, Hisabe T, Tsuruta O, Sano Y, Yamano H, Shimizu S, Yahagi N, Watanabe T, Nakamura H, Fujii T, Ishikawa H, Sugihara K (2015) Colorectal Endoscopic Resection Standardization Implementation Working Group of the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan. Local recurrence after endoscopic resection for large colorectal neoplasia: a multicenter prospective study in Japan. Am J Gastroenterol 110(5):697–707

    Article  PubMed  Google Scholar 

  13. Fujiya M, Tanaka K, Dokoshi T, Tominaga M, Ueno N, Inaba Y, Ito T, Moriichi K, Kohgo Y (2015) Efficacy and adverse events of EMR and endoscopic submucosal dissection for the treatment of colon neoplasms: a meta-analysis of studies comparing EMR and endoscopic submucosal dissection. Gastrointest Endosc 81(3):583–595

    Article  PubMed  Google Scholar 

  14. Khashab M, Eid E, Rusche M, Rex DK (2009) Incidence and predictors of “late” recurrences after endoscopic piecemeal resection of large sessile adenomas. Gastrointest Endosc 70(2):344–349

    Article  PubMed  Google Scholar 

  15. Knabe M, Pohl J, Gerges C, Ell C, Neuhaus H, Schumacher B (2014) Standardized long-term follow-up after endoscopic resection of large, nonpedunculated colorectal lesions: a prospective two-center study. Am J Gastroenterol 109(2):183–189

    Article  PubMed  Google Scholar 

  16. Samadder NJ, Curtin K, Tuohy TM, Pappas L, Boucher K, Provenzale D, Rowe KG, Mineau GP, Smith K, Pimentel R, Kirchhoff AC, Burt RW (2014) Characteristics of missed or interval colorectal cancer and patient survival: a population-based study. Gastroenterology 146(4):950–960

    Article  PubMed  Google Scholar 

  17. Binmoeller KF, Bohnhacker S, Seifert H et al (1996) Endoscopic snare excision of “giant” colorectal polyps. Gastrointest Endosc 43:183–188

    Article  CAS  PubMed  Google Scholar 

  18. Wu XR, Church JM, Jarrar A, Liang J, Kalady MF (2013) Risk factors for delayed postpolypectomy bleeding: how to minimize your patients’ risk. Int J Color Dis 28(8):1127–1134

    Article  Google Scholar 

  19. Seo JY, Chun J, Lee C, Hong KS, Im JP et al (2015) Novel risk stratification for recurrence after endoscopic resection of advanced colorectal adenoma. Gastrointest Endosc 81:655–664

    Article  PubMed  Google Scholar 

  20. Saito Y, Fukuzawa M, Matsuda T, Fukunaga S, Sakamoto T, Uraoka T et al (2010) Clinical outcome of endoscopic submucosal dissection versus endoscopic mucosal resection of large colorectal tumors as determined by curative resection. Surg Endosc 24(2):343–352

    Article  PubMed  Google Scholar 

  21. Belle S, Haase L, Pilz LR, Post S, Ebert M, Kaehler G (2014) Recurrence after endoscopic mucosal resection-therapy failure? Int J Color Dis 29(2):209–215

    Article  CAS  Google Scholar 

  22. Imai K, Hotta K, Yamaguchi Y, Tanaka M, Kakushima N, Takizawa K, Matsubayashi H, Kawata N, Igarashi K, Sugimoto S, Yoshida M, Oishi T, Mori K, Ono H (2014) Should laterally spreading tumors granular type be resected en bloc in endoscopic resections? Surg Endosc 28(7):2167–2173

    Article  PubMed  Google Scholar 

  23. Masci E, Viale E, Notaristefano C, Mangiavillano B, Fiori G, Crosta C, Dinelli M, Maino M, Viaggi P, Della Giustina F, Teruzzi V, Grasso G, Manes G, Zambelli S, Testoni PA (2013) Endoscopic mucosal resection in high- and low-volume centers: a prospective multicentric study. Surg Endosc 27(10):3799–3805

    Article  CAS  PubMed  Google Scholar 

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Author notes

    Authors and Affiliations

    1. Department of Gastroenterology & Interventional Endoscopy, Asklepios Hospital Barmbek, Semmelweis University, Medical Faculty, Campus Hamburg, Rübenkamp 220, 22291, Hamburg, Germany

      J. Seidel, E. Färber, R. Baumbach, W. Cordruwisch, U. Böhmler & S. Faiss

    2. MVZ Hanse Histologikum GmbH, Fangdieckstr. 75, 22547, Hamburg, Germany

      B. Feyerabend

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    1. J. Seidel
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    2. E. Färber
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    3. R. Baumbach
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    5. U. Böhmler
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    7. S. Faiss
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    Correspondence to S. Faiss.

    Additional information

    J. Seidel and E. Färber contributed equally to this work.

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    Seidel, J., Färber, E., Baumbach, R. et al. Complication and local recurrence rate after endoscopic resection of large high-risk colorectal adenomas of ≥3 cm in size. Int J Colorectal Dis 31, 603–611 (2016). https://doi.org/10.1007/s00384-015-2498-x

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    • DOI: https://doi.org/10.1007/s00384-015-2498-x

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