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Endoscopy 2023; 55(03): 267-273
DOI: 10.1055/a-1896-9798
Innovations and brief communications

Effect of pre-resection biopsy on detection of advanced dysplasia in large nonpedunculated colorectal polyps undergoing endoscopic mucosal resection

Michael X. Ma 
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
2   Department of Gastroenterology and Hepatology, Fiona Stanley Hospital, Perth, Australia
3   Department of Medicine, Midland St. John of God Hospital, Perth, Australia
,
David J. Tate 
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
4   University of Sydney, Sydney, Australia
,
Mayenaaz Sidhu
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
4   University of Sydney, Sydney, Australia
,
Simmi Zahid
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
4   University of Sydney, Sydney, Australia
,
Michael J. Bourke
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
4   University of Sydney, Sydney, Australia
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Referred to by:

Optimizing referral practices for resection of large colorectal polypsEndoscopy 2023; 55(03): 274-275
DOI: 10.1055/a-1961-7035

See also:

Comments on: “Effect of pre-resection biopsy on detection of advanced dysplasia in large nonpedunculated colorectal polyps undergoing endoscopic mucosal resection”Endoscopy 2023; 55(10): 975-975
DOI: 10.1055/a-2085-5532

Abstract

Background Pre-resection biopsy (PRB) of large nonpedunculated colorectal polyps (LNPCPs, ≥ 20 mm) is often performed before referral for endoscopic mucosal resection (EMR). How this affects the EMR procedure is unknown.

Methods This was a retrospective analysis of a prospectively collected cohort of patients with LNPCPs referred for EMR between 2013 to 2016 at an Australian tertiary center. Outcomes were differences between PRB and EMR histology, and effects of PRB on the EMR procedure.

Results Among 586 LNPCPs, lesions that underwent PRB were larger (median 35 vs. 30 mm; P < 0.007), and more commonly morphologically flat or slightly elevated (P = 0.01) compared with lesions without PRB. PRB histology was upstaged in 26.1 %, downstaged in 13.8 %, and unchanged in 60.1 % after EMR. Sensitivity of PRB was 77.2 % (95 %CI 71.1–82.4) for low grade dysplasia (LGD) and 21.2 % (95 %CI 11.5–35.1) for high grade dysplasia (HGD). Where EMR specimen showed HGD, PRB had detected LGD in 76.9 %. Where EMR specimen showed cancer, PRB had detected dysplasia only. PRB was associated with more submucosal fibrosis (P = 0.001) and intraprocedural bleeding (P = 0.03). EMR success or recurrence was not affected.

Conclusions Routine PRB of LNPCP did not reliably detect advanced histology and may have affected EMR complexity. PRB should be utilized with caution in guiding endoscopic management of LNPCPs.

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Publication History

Received: 31 August 2021

Accepted after revision: 11 July 2022

Accepted Manuscript online:
11 July 2022

Article published online:
31 August 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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