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Outcomes of endoscopic treatment of second recurrences of large nonpedunculated colorectal adenomas

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Abstract

Background and aims

Piecemeal endoscopic mucosal resection (EMR) of large nonpedunculated colorectal adenomas is associated with significant recurrence rates. After salvage endoscopic treatment of recurrences, there is a significant rate of second recurrences. There is a paucity of data on the efficacy and safety of continued endoscopic treatment after a second recurrence.

Methods

Consecutive patients with recurrent adenomas after initial piecemeal EMR of nonpedunculated colorectal adenomas >2 cm were reviewed. We assessed the feasibility, safety and efficacy of continued endoscopic treatment in these patients.

Results

Sixty-four patients with 70 recurrent lesions were identified. All were retreated endoscopically. Follow-up colonoscopy (mean interval 6.4 months) was performed on 62/70 lesions (89 %), and a second recurrence was found in 21/62 (34 %). One patient underwent surgery for a circumferential adenoma of the ileocecal valve. The other 20 lesions were treated endoscopically. Follow-up colonoscopy was performed on 15/20 (75 %) and demonstrated a third recurrence in 3/15 (20 %). One was a deep T1 cancer; curative surgery was performed. The other two patients each had one additional endoscopic treatment and both had no recurrence on subsequent colonoscopy. There were two complications: Both were delayed bleeds after treatment of the first recurrence. A mean of 1.3 endoscopic procedures was required to achieve a cure (range 1–3) for recurrent adenomas after piecemeal EMR.

Conclusion

Endoscopic treatment of patients with second recurrences is safe and effective, but is associated with a significant rate of additional recurrences. Continued endoscopic treatment of patients with multiple recurrences is associated with high cure rates, low complication rates and a low risk of progression to malignancy.

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Authors and Affiliations

  1. Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea

    Hyun Gun Kim

  2. Department of Gastroenterology, Stanford University School of Medicine, Stanford, CA, USA

    Hyun Gun Kim, Saurabh Sethi, Subhas Banerjee & Shai Friedland

  3. VA Palo Alto Health Care System, 711 Middlefield Road, Palo Alto, CA, 94301, USA

    Shai Friedland

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  1. Hyun Gun Kim
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  2. Saurabh Sethi
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  3. Subhas Banerjee
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  4. Shai Friedland
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Corresponding author

Correspondence to Shai Friedland.

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Disclosures

Drs. Kim, Sethi, Banerjee and Friedland have no conflicts of interest or financial ties to disclose.

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Kim, H.G., Sethi, S., Banerjee, S. et al. Outcomes of endoscopic treatment of second recurrences of large nonpedunculated colorectal adenomas. Surg Endosc 30, 2457–2464 (2016). https://doi.org/10.1007/s00464-015-4497-y

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  • DOI: https://doi.org/10.1007/s00464-015-4497-y

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