EFFICACY AND SAFETY OF ENDOSCOPIC TREATMENT FOR RECURRENCE OF NON-INVASIVE COLORECTAL LESIONS AFTER PIECEMEAL ENDOSCOPIC MUCOSAL RESECTION

Aims:

Piecemeal endoscopic mucosal resection (EMR) allows the resection of large non-invasive colorectal lesions. Endoscopic surveillance is recommended 3 – 6 months after treatment to evaluate recurrence adenoma, which occurs in 15 – 20% of the cases.

This study aims to evaluate the efficacy and safety of endoscopic treatment of recurrent lesions identified in first colonoscopy surveillance after a first piecemeal EMR (pEMR) of non-invasive colorectal lesions and to determine predictive factors for therapeutic success.

Methods:

All patients who underwent surveillance colonoscopy 3 – 6 months after pEMR of a non-invasive colorectal lesion between 2012 and 2017 were included. In cases of macroscopic recurrence, endoscopic resection was attempted with snare and/or ablation techniques.

Results:

Of p234 EMR, 166 (70.9%) had no evidence of macroscopic recurrence and in 68 (29.1%) had endoscopic recurrent lesion.

In patients without macroscopic evidence of recurrence, the EMR scar was identified in 127 (76.5%), and cold forceps biopsy was performed in 108 (85%). Histological residual adenoma was identified in 6 patients (5.5%).

Considering patients with macroscopic recurrence, the mean age was 64.4 years (SD ± 10.1), and 77.9% were men. The mean size of recurrent lesions was 11.2 mm (SD ± 7.4). In 89.7% of recurrent lesions, a successful endoscopic resection with snare was achieved. Smaller recurrent adenomas (p < 0.001) and absence of endoscopically documented fibrosis (p < 0.001) were significantly associated with technical success. The most common cause of failure was the presence of nonlifting lesions (5.9%). Only 4.4% of the patients were referred for surgery. Post-EMR bleeding was the only complication (3%).

Conclusions:

Reccurent lesions after pEMR were frequent. Endoscopic resection of recurrent lesions in EMR scar is safe and effective, mainly in smaller lesions with no evidence of fibrosis.