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CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(11): E1820-E1826
DOI: 10.1055/a-1578-1965
Original article

Endoscopic resection outcomes and predictors of failed en bloc endoscopic mucosal resection of colorectal polyps ≤ 20 mm among advanced endoscopy trainees

William W. King
1   Department of Medicine, University of Florida, Gainesville, Florida, United States
,
Peter V. Draganov
2   Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, United States
,
Andrew Y. Wang
3   Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, United States
,
Dushant Uppal
3   Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, United States
,
Amir Rumman
3   Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, United States
,
Nikhil A. Kumta
4   Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
,
Christopher J. DiMaio
4   Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
,
Arvind J. Trindade
5   Division of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York, United States
,
Divyesh V. Sejpal
5   Division of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York, United States
,
Lionel S. D’Souza
6   Division of Gastroenterology and Hepatology, Stony Brook University Hospital, Stony Brook, New York, United States
,
Juan C. Bucobo
6   Division of Gastroenterology and Hepatology, Stony Brook University Hospital, Stony Brook, New York, United States
,
Victoria Gomez
7   Department of Gastroenterology, Mayo Clinic, Jacksonville, Florida, United States
,
Michael B. Wallace
8   Division of Gastroenterology and Hepatology, Sheikh Shakbout Medical City, Abu Dhabi, United Arab Emirates
,
Heiko Pohl
9   Department of Gastroenterology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Department of Gastroenterology, Veterans Administration Medical Center, White River Junction, Vermont
,
Dennis Yang
2   Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, United States
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Abstract

Background and study aims En bloc endoscopic mucosal resection (EMR) is preferred over piecemeal resection for polyps ≤ 20 mm. Data on colorectal EMR training are limited. We aimed to evaluate the en bloc EMR rate of polyps ≤ 20 mm among advanced endoscopy trainees and to identify predictors of failed en bloc EMR.

Methods This was a multicenter prospective study evaluating trainee performance in EMR during advanced endoscopy fellowship. A logistic regression model was used to identify the number of procedures and lesion cut-off size associated with an en bloc EMR rate of ≥ 80 %. Multivariate analysis was performed to identify predictors of failed en bloc EMR.

Results Six trainees from six centers performed 189 colorectal EMRs, of which 104 (55 %) were for polyps ≤ 20 mm. Of these, 57.7 % (60/104) were resected en bloc. Trainees with ≥ 30 EMRs (OR 6.80; 95 % CI: 2.80–16.50; P = 0.00001) and lesions ≤ 17 mm (OR 4.56;95 CI:1.23–16.88; P = 0.02) were more likely to be associated with an en bloc EMR rate of ≥ 80 %. Independent predictors of failed en bloc EMR on multivariate analysis included: larger polyp size (OR:6.83;95 % CI:2.55–18.4; P = 0.0001), right colon location (OR:7.15; 95 % CI:1.31–38.9; P = 0.02), increased procedural difficulty (OR 2.99; 95 % CI:1.13–7.91; P = 0.03), and having performed < 30 EMRs (OR: 4.87; 95 %CI: 1.05–22.61; P = 0.04).

Conclusions In this pilot study, we demonstrated that a relatively low proportion of trainees achieved en bloc EMR for polyps ≤ 20 mm and identified procedure volume and lesion size thresholds for successful en bloc EMR and independent predictors for failed en bloc resection. These preliminary results support the need for future efforts to define EMR procedure competence thresholds during training.



Publication History

Received: 24 April 2021

Accepted: 22 July 2021

Article published online:
12 November 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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