Endoscopic mucosal resection for large serrated lesions in comparison with adenomas: A prospective multicentre study of 2000 lesions

Maria Pellise, Nicholas G. Burgess, Nicholas Tutticci, Luke F. Hourigan, Simon A. Zanati, Gregor J. Brown, Rajvinder Singh, Stephen J. Williams, Spiro C. Raftopoulos, Donald Ormonde, Alan Moss, Karen Byth, Heok P'Ng, Hema Mahajan, Duncan McLeod, Michael J. Bourke

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Abstract

Objective: Endoscopic mucosal resection (EMR) is effective for large laterally spreading flat and sessile lesions (LSLs). Sessile serrated adenomas/polyps (SSA/Ps) are linked to the relative failure of colonoscopy to prevent proximal colorectal cancer. We aimed to examine the technical success, adverse events and recurrence following EMR for large SSA/Ps in comparison with large conventional adenomas. Design: Over 74 months till August 2014, prospective multicentre data of LSLs ≥20 mm were analysed. A standardised dye-based conventional EMR technique followed by scheduled surveillance colonoscopy was used. Results: From a total of 2000 lesions, 323 SSA/Ps in 246 patients and 1527 adenomas in 1425 patients were included for analysis. Technical success for EMR was superior in SSA/Ps compared with adenomas (99.1% vs 94.5%, p<0.001). Significant bleeding and perforation were similar in both cohorts. The cumulative recurrence rates for adenomas after 6, 12, 18 and 24 months were 16.1%, 20.4%, 23.4% and 28.4%, respectively. For SSA/Ps, they were 6.3% at 6 months and 7.0% from 12 months onwards (p<0.001). Following multivariable adjustment, the HR of recurrence for adenomas versus SSA/Ps was 1.7 (95% CI 0.9 to 3.0, p=0.097). Subgroup analysis by lesion size revealed an eightfold increased risk of recurrence for 20-25 mm adenomas versus SSA/Ps, but no significantly different risk between lesion types in larger lesion groups. Conclusion: Recurrence after EMR of 20-25 mm LSLs is significantly less frequent in SSA/Ps compared with adenomatous lesions. SSA/Ps can be more effectively removed than adenomatous LSLs with equivalent safety. Ensuring complete initial resection is imperative for avoiding recurrence. Trial registration number: ClinicalTrials.gov NCT01368289.

Original languageEnglish
Pages (from-to)644-653
Number of pages10
JournalGut
Volume66
Issue number4
DOIs
Publication statusPublished - Apr 2017
Externally publishedYes

Cite this

Pellise, M., Burgess, N. G., Tutticci, N., Hourigan, L. F., Zanati, S. A., Brown, G. J., Singh, R., Williams, S. J., Raftopoulos, S. C., Ormonde, D., Moss, A., Byth, K., P'Ng, H., Mahajan, H., McLeod, D., & Bourke, M. J. (2017). Endoscopic mucosal resection for large serrated lesions in comparison with adenomas: A prospective multicentre study of 2000 lesions. Gut, 66(4), 644-653. https://doi.org/10.1136/gutjnl-2015-310249