ASSESSING PROCEDURE OUTCOMES FOLLOWING PIECEMEAL COLD SNARE ENDOSCOPIC MUCOSAL RESECTION OF LARGE NON-PEDUNCULATED COLORECTAL POLYPS

Document Type

Conference Proceeding

Publication Date

6-1-2024

Publication Title

Gastrointest Endosc

Abstract

Introduction: Cold snare endoscopic mucosal resection (CS-EMR) has gained popularity for the treatment of large complex non-pedunculated colorectal polyps (LNPCRPs). CS-EMR’s popularity has grown due to the reported lower risk of adverse events (AEs). However, data on polyp recurrence rates and optimal follow up are scarce. Current guidelines recommend surveillance colonoscopy within 3 to 6 months following piecemeal EMR to evaluate for residual/recurrent adenoma (RRA) but there remains limited guidance on appropriate intervention when recurrence occurs. We aimed to evaluate the management and outcomes of RRA after CS-EMR. Methods: A single-center retrospective study was performed on patients with RRA on surveillance colonoscopy following CS-EMR of LNPCRPs between 1/1/2019 and 1/1/2021. Primary outcomes studied included RRA management, development of interval cancer, the number of procedures needed to achieve complete eradication when RRA is found, the risk of AEs on follow-up procedures, and the need for surgical intervention. Results: Our study included 105 patients (48% female; 53% caucasian) who underwent CS-EMR on index colonoscopy (polyp size range 20 to 80 mm, mean 33.8). Most of the polyps were identified in the cecum (35%) or ascending colon (29%). The majority of polyps were tubular adenomas or tubulovillous adenomas (35% and 58%). Among 105 patients, 94 cases (89%) were found to have RRA on first surveillance colonoscopy. Endoscopic resection was performed using a variety of techniques including cold snare (92%), cold biopsy (63%), APC (39%), and hot snare (6%). Eight patients received clips after resection. Out of the 38 patients treated with APC, 20 (53%) had RRA on subsequent follow up colonoscopy. The only reported AEs were intraprocedural and delayed bleeding (3.8% each), and 3 cases were hospitalized for a mean of 3.6 days . Sixty-seven patients (64%) received a second follow up colonoscopy, 28 of whom had RRA (42%). Additional follow up surveillance colonoscopy data was available for 32 patients, among which RRA was recognized in only 9 cases (28%). Within our entire cohort, no patients developed interval adenocarcinoma and only 3 cases needed referrals for surgical management (3%). In addition, the specific type of adjunctive endoscopic therapy during surveillance colonoscopy did not affect patient outcomes (Table 2). Discussion: CS-EMR appears to be a safe and effective endoscopic technique for the treatment of LNPCRPs. Despite having relatively high rates of RRA, with appropriate colonoscopy surveillance and utilization of multiple resection modalities, patients had low adverse event rates, did not develop interval colon cancer and rarely needed further surgical interventions, thus supportive of the overall effectiveness of this technique even in very large polyps such as within this cohort.

Volume

99

Issue

6

First Page

AB520

Last Page

AB521

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