Endoscopy 2018; 50(04): S54
DOI: 10.1055/s-0038-1637188
ESGE Days 2018 oral presentations
20.04.2018 – Best abstract awards
Georg Thieme Verlag KG Stuttgart · New York

MANAGEMENT OF RESECTION OF LARGE COLONIC LESIONS IN A REAL-LIFE SETTING: THE SCALP STUDY

, Bowell Group
A Amato
1   Valduce Hospital, Como, Italy
,
F Radaelli
1   Valduce Hospital, Como, Italy
,
V Cennamo
2   Maggiore Hospital, Bologna, Italy
,
E Di Giulio
3   Sant'Andrea Hospital, Roma, Italy
,
L Fuccio
4   Policlinico Sant'Orsola, Bologna, Italy
,
G Manes
5   ASST Rhodense, Garbagnate, Italy
,
O Tarantino
6   San Giuseppe Hospital, Empoli, Italy
,
G Fiori
7   European Institute of Oncology, Milano, Italy
,
M De Bellis
8   National Cancer Institute, Napoli, Italy
,
A Buda
9   Santa Maria del Prato Hospital, Feltre, Italy
,
F Pigò
10   New Civil Hospital S. Agostino Estense, Modena, Italy
,
P Cesaro
11   Fondazione Poliambulanza, Brescia, Italy
,
P Occhipinti
12   Maggiore Carità Hospital, Novara, Italy
,
G Feliciangeli
13   ASUR Marche AV3, Macerata, Italy
,
M Manno
14   Ramazzini Hospital, Carpi, Italy
,
P Dulbwcco
15   University of Genoa, Genoa, Italy
,
A Musso
16   AOU Città della Salute e della Scienza, Torino, Italy
,
G Gullotti
17   A.O.U. Policlinico G. Martino, Messina, Italy
,
M Giardini
18   Urbino Hospital, Urbino, Italy
,
B Mangiavillano
19   Humanitas Mater Domini, Castellanza, Italy
,
S Paggi
1   Valduce Hospital, Como, Italy
,
C Hassan
20   Nuovo Regina Margherita Hospital, Roma, Italy
,
A Repici
21   Humanitas Research Hospital, Humanitas University, Milano, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

Also available at
 

Aims:

Endoscopic resection of large colonic lesions (LCLs, > 20 mm) is effective and associated with low rate of complications when performed by trained endoscopists in resourced centers. Aim of present study is to evaluate the reproducibility of good performance of endoscopic resection of LCLs outside referral centers.

Methods:

In a prospective, multicenter, observational study in 20 centers, data from consecutive resections of LCLs performed over a 6-month period were collected. Patients were enrolled at procedure-time and followed-up at 15 days for complications and at 6 months for recurrence.

Results:

1650 LCLs (mean size 32.4 mm; 41.5% lateral spreading tumor, 29.3% sessile, and 29.6% pedunculated) removed in 1504 patients were analysed. An endoscopic mucosal resection (EMR) was performed in 58.8%, polypectomy in 30.8%, underwater EMR in 1.3% and endoscopic submucosal dissection in 6.1% of the lesions. 21.8%% of the patients were on antithrombotics (55.9% aspirin, 17.7% thienopyridines, 4.8% dual antiplatelet, 14.9% vitamin K antagonists, 6.7% direct oral anticoagulants). Most patients suspended antithrombotic according to the guidelines ESGE. Overall, intra-procedural bleeding requiring endoscopic therapy occurred in 8.2% of patients; 29% of them were on antithrombotics. At multivariate analysis, intra-procedural bleeding correlated with polyp size (OR 1.04 95% CI 1.02 – 1.06), and inversely with execution of pre- and post-resection prophylaxis maneuvers (OR 0.61 95% CI 0.38 – 0.99 and OR 0.40 95% CI 0.25 – 0.66, respectively). Delayed bleeding occurred in 4.5% of the subjects, perforation in 0.9% of patients (86.7% endoscopically managed). At the moment, 6-months follow-up is available for 51.1% of the patients; of them 19% had recurrence. At multivariate analysis efficacy was inversely associated with intra-procedural bleeding (OR 2.61 95% CI 1.14 – 5.96).

Conclusions:

In a real-life setting the management of resection of LCLs varies widely. The efficacy correlates inversely with intra-procedural bleeding, which is in turn associated with polyp size and prophylactic maneuvers. Complication rate is marginal even in this setting.