Endoscopic Surveillance of Piecemeal Endoscopic Mucosal Resection of Colorectal Lesions: Should we Stratify?

Aims Recurrence rates up to 24 % after piecemeal endoscopic resection (pEMRc) of colorectal lesions >20 mm provides the rationale to recommend a standardized surveillance program. We intended to assess endoscopic recurrence rate and its predictors over 5 years of follow-up and to determine safety of a personalized surveillance strategy based on risk factors.

Methods Single centre prospective cohort study of colorectal lesions submitted to pEMRc since 2009 with a minimal follow-up of 5 years. Demographic, endoscopic and histologic data were retrieved from medical records. Risk factors for early and late recurrence were evaluated by multivariate regression. SERT score was applied to evaluated recurrence risk. Area under the curve (AUC) was calculated to evaluate SERT score as recurrence predictor.

Results A total of 188 patients were included, corresponding to 205 lesions [male gender: 64 % (n=121); median age: 70 (12)]. Mean follow-up time was 55 (12.7) months. Lesion median size was 30 (15) mm. Most lesions were located at the ascending colon (n=105; 52 %), 86 % (n=176) were granular homogeneous laterally spreading tumours and 47 % (n=96) had high-grade dysplasia. Six, 18, 36 and 60 months recurrence rates were 17 %, 6 %, 1.5 % and 0 %. Lesion size³ 40 mm (OR 3.3, 95 %CI: 1.3-8.5) and difficult access (OR 1.8, 95 %CI: 1.1-2.8) were predictors of 6 months recurrence. SERT=0 was a negative predictor for 6 months recurrence (OR 0.2, 95 % CI:0.1-0.6). Only high-grade dysplasia (OR 4, 95 % CI 1.1-15) was identified as predictor for eighteen months recurrence. SERT score was able to predict recurrence with an AUC of 0.76 (0.68-0.84).

Conclusions Current surveillance protocol for colorectal lesions resected by pEMRc is effective. However, SERT=0 lesions could safely undergo first surveillance at 18 months. These conclusions are in line with previous published data and could reduce the burden of pEMR on patients and health systems.

Citation: João M, Taveira F, Areia M et al. OP107 ENDOSCOPIC SURVEILLANCE OF PIECEMEAL ENDOSCOPIC MUCOSAL RESECTION OF COLORECTAL LESIONS: SHOULD WE STRATIFY? Endoscopy 2021; 53: S45.

Publication History

Article published online:
19 March 2021