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Endoscopy 2010; 42(10): 806-813
DOI: 10.1055/s-0030-1255715
Original article

© Georg Thieme Verlag KG Stuttgart · New York

A national survey of endoscopic mucosal resection for superficial gastrointestinal neoplasia

D.  Heresbach1 , R.  Kornhauser1 , J.  A.  Seyrig1 , D.  Coumaros1 , C.  Claviere1 , A.  Bury1 , J.  Cottereau1 , J.  M.  Canard1 , S.  Chaussade1 , A.  Baudet1 , A.  Casteur1 , O.  Duval1 , T.  Ponchon1, of the OMEGA group
  • 1Observatoire de la Mucosectomie Endoscopique en Gastroenterologie (OMEGA), under the aegis of the Société Française d’Endoscopie Digestive (SFED), Paris, France
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Publication History

submitted 14 December 2009

accepted after revision 14 June 2010

Publication Date:
06 September 2010 (online)

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Commentaire de travail de D. Heresbach et al., pp. 806Endoscopy 2010; 42(10): 883-883
DOI: 10.1055/s-0032-1306718

Background and study aim: Studies on endoscopic mucosal resection (EMR) are mostly based on data from centers with high expertise. We report the average EMR results in a national survey of consecutive patients in France.

Methods: A 1-year survey was carried out to record immediate outcome data of all EMRs performed, regardless of lesion size or gastrointestinal location.

Results: Overall, 1335 EMRs in 1210 patients were reported by 241 of the 736 gastroenterologists who performed such procedures (33 %). Resections were done for upper gastrointestinal lesions in 125 cases (41 esophageal, 43 gastric, and 41 duodenal lesions), in 45 % of cases using specific EMR techniques such as ligation, cap, or traction. The technique for resecting the 1210 lower gastrointestinal lesions mostly consisted of saline-assisted polypectomy or EMR, with specific techniques used in only 2.2 %. En bloc resection was less common with esophageal (46 %) or duodenal (54 %) neoplasms than in the lower gastrointestinal tract (73 %); size also had some influence (53 % > 1 cm vs. 92 % ≤ 1 cm). The overall complication rate was 5.2 %; the rate was lower for lesions 1 cm or smaller (0.6 % vs. 4.6 %). Fifty-four early and 17 delayed complications were recorded, in 12 % of upper gastrointestinal and 4.6 % of colonic lesions. Surgery became necessary in 1.6 % for upper and 2.9 % for lower gastrointestinal neoplasms. No association was seen between physician EMR caseload and either en bloc resection rate or complication rate.

Conclusions: EMR in general, especially saline-assisted polypectomy in the colon, appears to be reasonably safe even when performed by nonexperts. EMR for larger or for upper gastrointestinal lesions should probably be limited to high-volume centers.

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D. HeresbachMD, PhD 

Service des Maladies de l’Appareil Digestif – CHU Pontchaillou

35033 – Rennes Cedex 09
France

Email: denis.heresbach@chu-rennes.fr