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CC BY 4.0 · Endoscopy
DOI: 10.1055/a-2498-7114
Original article

Optical assessment of scars after endoscopic mucosal resection of large colorectal polyps in a multicenter, community hospital setting: is routine biopsy still necessary?

Lonne W.T. Meulen 
1   Department of Gastroenterology and Hepatology, Maastricht University Medical Centre+, Maastricht, Netherlands (Ringgold ID: RIN199236)
2   GROW School for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands (Ringgold ID: RIN5211)
,
Roel M.M. Bogie
1   Department of Gastroenterology and Hepatology, Maastricht University Medical Centre+, Maastricht, Netherlands (Ringgold ID: RIN199236)
,
Peter D. Siersema
3   Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, Netherlands (Ringgold ID: RIN6993)
,
Bjorn Winkens
4   Department of Methodology and Statistics, Maastricht University, Maastricht, Netherlands (Ringgold ID: RIN5211)
5   CAPHRI, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands (Ringgold ID: RIN5211)
,
Marije S. Vlug
6   Department of Gastroenterology and Hepatology, Dijklander Hospital, Hoorn, Netherlands (Ringgold ID: RIN3956)
,
Frank H.J. Wolfhagen
7   Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht, Netherlands (Ringgold ID: RIN2998)
,
Martine A.M.C. Baven-Pronk
8   Department of Gastroenterology and Hepatology, Groene Hart Hospital, Gouda, Netherlands (Ringgold ID: RIN3573)
,
Michael P.J.A. van der Voorn
9   Department of Gastroenterology and Hepatology, Haga Hospital, Den Haag, Netherlands (Ringgold ID: RIN37134)
,
M. P. Schwartz
10   Department of Gastroenterology and Hepatology, Meander Medical Centre, Amersfoort, Netherlands (Ringgold ID: RIN1170)
,
Lauran Vogelaar
11   Department of Gastroenterology and Hepatology, Diakonessenhuis Utrecht Zeist Doorn, Utrecht, Netherlands (Ringgold ID: RIN8118)
,
Tom C.J. Seerden
12   Gastroenterology and Hepatology, Amphia Hospital Location Langendijk, Breda, Netherlands (Ringgold ID: RIN89554)
,
W.L. Hazen
13   Department of Gastroenterology and Hepatology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, Netherlands (Ringgold ID: RIN7898)
,
R W.M. Schrauwen
14   Department of Gastroenterology and Hepatology, Bernhoven Hospital Location Uden, Uden, Netherlands (Ringgold ID: RIN97772)
,
Lorenza Alvarez Herrero
15   Department of Gastroenterology and hepatology, Sint Antonius Hospital, Nieuwegein, Netherlands (Ringgold ID: RIN6028)
,
Ramon Michel Schreuder
16   Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, Netherlands (Ringgold ID: RIN3168)
,
Annick B van Nunen
17   Department of Gastroenterology and Hepatology, Zuyderland Medical Centre, Sittard-Geleen, Netherlands (Ringgold ID: RIN159205)
,
Gijs J de Bruin
18   Department of Gastroenterology and Hepatology, Tergooi Medical Centre, Hilversum, Netherlands (Ringgold ID: RIN3913)
,
Willem A. Marsman
19   Department of Gastroenterology and Hepatology, Spaarne Gasthuis, Haarlem, Netherlands (Ringgold ID: RIN3670)
,
Marc de Bièvre
20   Department of Gastroenterology and Hepatology,, VieCuri Medical Centre, Venlo, Netherlands (Ringgold ID: RIN8187)
,
Robert Roomer
21   Department of Gastroenterology and Hepatology, Franciscus Gasthuis en Vlietland, Rotterdam, Netherlands (Ringgold ID: RIN425659)
,
Rogier de Ridder
1   Department of Gastroenterology and Hepatology, Maastricht University Medical Centre+, Maastricht, Netherlands (Ringgold ID: RIN199236)
,
Maria Pellisé 
22   Department of Gastroenterology and Hepatology, Hospital Clinic de Barcelona, Barcelona, Spain (Ringgold ID: RIN16493)
,
Michael J. Bourke
23   Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia (Ringgold ID: RIN8539)
,
Ad Masclee
1   Department of Gastroenterology and Hepatology, Maastricht University Medical Centre+, Maastricht, Netherlands (Ringgold ID: RIN199236)
,
Leon MG Moons
24   Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, Netherlands (Ringgold ID: RIN8124)
› Author AffiliationsSupported by: KWF Kankerbestrijding 2017-10089

Clinical Trial: Registration number (trial ID): NTR7477, Trial registry: Netherlands National Trial Register (http://www.trialregister.nl), Type of Study: Multicentre cluster randomised trial
› Further Information
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Background and study aims: Piecemeal EMR of large (≥20mm) non-pedunculated colorectal polyps (LNPCPs) is succeeded by a 6-month surveillance endoscopy to evaluate the post-EMR scar for recurrence. Data from expert centers suggest that routine tattoo placement and scar biopsies can be omitted, but data from community hospitals are lacking. Patients and methods: In a post-hoc analysis of the STAR-LNPCP study (NTR7477), containing prospective data on 6-month post-pEMR scar assessments in 30 Dutch community hospitals (October 2019 to May 2022), the agreement between optical assessment and histological confirmation by routine biopsies was evaluated. Documentation of optical characteristics, imaging, and biopsies of the post-EMR scar were performed according to a standardized protocol. Results: In 1277 post-EMR scar assessments, identification of the scar was achieved in 1215/1277 (95%). Tattoo placement did not influence scar identification. Scar biopsy was performed in 1050/1215 cases (86%). Recurrences were seen in 200/1050 cases (19%). There was a good agreement between optical assessment of recurrence and histological confirmation (Cohen’s kappa 0.78 [0.73-0.83]). The NPV was 98% [97-99%] and the PPV was 74% [68-80%]. Higher false positive rate was seen after prior use of clips (11% vs. 5%, p=0.017). Dedicated endoscopists identified the scar more often (96% vs. 88%, p<0.001), and showed a lower optical recurrence miss rate (1%vs. 3%, p=0.111) compared to non-dedicated endoscopists. Conclusion: Based on this multicenter community hospital study, routine tattoo placement and scar biopsies of the post-EMR scar can be omitted. Assessment of post-EMR scars by dedicated endoscopists is advised.



Publication History

Received: 31 January 2024

Accepted after revision: 07 December 2024

Accepted Manuscript online:
09 December 2024

© . The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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