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Circumferential submucosal incision prior to endoscopic mucosal resection versus conventional endoscopic mucosal resection for colorectal lesions with endoscopic features of sessile serrated lesions

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Abstract

Background and aims

Sessile serrated lesions (SSLs) are more prone to incomplete resection than conventional adenomas. This study evaluated whether circumferential submucosal incision prior to endoscopic mucosal resection (CSI-EMR) can increase the rate of complete and en bloc resections of colorectal lesions with endoscopic features of SSL.

Methods

Retrospective analyses and propensity score matching were performed for the resection of colorectal lesions ≥ 10 mm with endoscopic features of SSL.

Results

After 1:1 ratio matching, 127 lesions in the CSI-EMR group and 127 in the EMR group were selected for analysis. The median size of the lesions was 15 mm (IQR 12–16) in both groups. There was no significant difference in either the complete resection rate or en bloc resection rate between CSI-EMR and EMR groups (96.9% vs. 92.9%, P = 0.155; 92.1% vs. 89.0%, P = 0.391). By contrast, the R0 resection rate was significantly higher in the CSI-EMR group than in the EMR group (89.8% vs. 59.8%, P < 0.001). The median procedure time was significantly longer in the CSI-EMR group than in the EMR group (6.28 min vs. 2.55 min, P < 0.001), whereas there was no significant difference between the two groups in the incidence of adverse events or recurrence rate. Multivariate analysis showed that CSI-EMR was the only factor significantly associated with R0 resection (P < 0.001).

Conclusions

For colorectal lesions with endoscopic features of SSL, CSI-EMR does not increase the complete or en bloc resection rate, but does increase the R0 resection rate. The procedure time is longer for CSI-EMR than EMR. The association of CSI-EMR with R0 resection and non-recurrence should be further evaluated.

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Abbreviations

SSL:

Sessile serrated lesion

CSI-EMR:

Circumferential submucosal incision prior to endoscopic mucosal resection

EMR:

Endoscopic mucosal resection

HPs:

Hyperplastic polyps

IQR:

Interquartile range

SMD:

Standardized mean difference

OR:

Odd ratios

CI:

Confidence interval

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, Korea

    Chang Kyo Oh, Bo-In Lee, Seung-Jun Kim, Yu Kyung Cho, Jae Myung Park, Young-Seok Cho, In Seok Lee & Myung-Gyu Choi

  2. Departments of Hospital Pathology, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, Korea

    Sung Hak Lee

  3. Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Yeouido St. Mary’s Hospital, The Catholic University of Korea, 10, 63-ro, Yeongdeungpo-gu, Seoul, Korea

    Han Hee Lee

  4. Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Eunpyeong St. Mary’s Hospital, The Catholic University of Korea, 1021,Tongil Ro, Eunpyeong-gu, Seoul, Korea

    Chul-Hyun Lim & Jin Su Kim

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  1. Chang Kyo Oh
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Corresponding authors

Correspondence to Bo-In Lee or Sung Hak Lee.

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Disclosures

Dr. Bo-In Lee was consultant to Taejoon Pharm, Pentax. Co., Olympus Co., Abbvie Co., and Medtronics Co. Drs. Chang Kyo Oh, Sung Hak Lee, Seung-Jun Kim, Han Hee Lee, Chul-Hyun Lim, Jin Su Kim, Yu Kyung Cho, Jae Myung Park, Young-Seok Cho, In Seok Lee, and Myung-Gyu Choi have no conflicts of interest or financial ties to disclose.

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The study protocol was approved by the Institutional Review Board of the Catholic Medical Center.

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Oh, C., Lee, BI., Lee, S. et al. Circumferential submucosal incision prior to endoscopic mucosal resection versus conventional endoscopic mucosal resection for colorectal lesions with endoscopic features of sessile serrated lesions. Surg Endosc 36, 2087–2095 (2022). https://doi.org/10.1007/s00464-021-08495-x

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