Reply to Jiang et al.

We thank Jiang et al. for their insightful comments on our study [11]. We recognize that our recurrence rate is higher than previously reported for piecemeal endoscopic mucosal resection (EMR) of nonpedunculated lesions ≥20 mm. However, we described a clinically common situation, especially when dealing with medium-sized lesions removed during diagnostic procedures outside specific lists. We included a high proportion of post-EMR scars that were sessile serrated lesions (47.4%) at the index colonoscopy, lesions that are more prone to incomplete resection [22].

Second, endoscopists who performed the index procedures were not the same as those who conducted the surveillance. The mix of fellows, general gastroenterologists, and endoscopists performing the index procedures could partially explain the results.

Finally, most of the index procedures were conducted before the evidence became available for ablation of margins post-EMR [33], which has been shown to reduce recurrence rates. En bloc resection of lesions would have probably resulted in a lower recurrence rate, but this was not the aim of our study.

We acknowledge that the prevalence of the disease (recurrence) could impact the positive and negative predictive values reported. However, the pragmatic selection of eligible patients reflects real clinical practice in many settings.

Finally, we agree that combining LCI with artificial intelligence could enhance diagnostic performance in detecting recurrence on post-polypectomy scars and warrants further research. This is a very interesting scenario that we would also like to address in the future.

Publication History

Article published online:
30 October 2024

• References

• 1 Ortiz O, Daca-Alvarez M, Rivero-Sánchez L. et al. Linked-color imaging versus high definition white-light endoscopy for evaluation of post-polypectomy scars of nonpedunculated lesions: LCI-Scar study. Endoscopy 2024; 56: 283-290 DOI: 10.1055/a-2204-3236. (PMID: 37931908)
• 2 Pohl H, Srivastava A, Bensen SP. et al. Incomplete polyp resection during colonoscopy – results of the complete adenoma resection (CARE) study. Gastroenterology 2013; 144: 74-80.e1
• 3 Klein A, Tate DJ, Jayasekeran V. et al. Thermal ablation of mucosal defect margins reduces adenoma recurrence after colonic endoscopic mucosal resection. Gastroenterology 2019; 156: 604-613.e3