title: Short- and long-term outcomes of standardized EMR of nonpolypoid (flat and depressed) colorectal lesions > or = 1 cm (with video).
abstract: BACKGROUND
  Nonpolypoid (flat and depressed) colorectal lesions are increasingly recognized. Their endoscopic removal requires specialized EMR techniques, which are more complex to perform. Outcomes data on EMR of nonpolypoid neoplasms in the United States is needed.
  
  
  OBJECTIVE
  To determine the safety and efficacy of EMR in the resection of nonpolypoid colorectal neoplasms > or = 1 cm.
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  Veterans Affairs Palo Alto Health Care System.
  
  
  METHODS
  Over a 5-year period, patients who underwent EMR for nonpolypoid colorectal lesions > or = 1 cm.
  
  
  METHODS
  A standardized approach that included lesion assessment, classification, inject-and-cut EMR technique, reassessment, and treatment of residual tissue.
  
  
  METHODS
  Complete resection, bleeding, perforation, development of advanced cancer, and death.
  
  
  RESULTS
  A total of 100 patients (125 lesions: 117 flat and 8 depressed) met inclusion criteria. Mean size was 16.7 +/- 7 mm (range, 10-50 mm). Histology included 5 submucosal invasive cancers, 5 carcinomas in situ, and 91 adenomas. Thirty-eight patients (48 lesions) did not receive surveillance colonoscopy: 8 had surgery, 16 had hyperplastic pathology, and 14 did not undergo repeat examination. Surveillance colonoscopy was performed on 62 patients (77 lesions). Complete resection was achieved in 100% of these patients after 1 to 3 surveillance colonoscopies. All patients received follow-up (mean [standard deviation] = 4.5 +/- 1.4 years); none developed colorectal cancer or metastasis.
  
  
  CONCLUSIONS
  Single endoscopist, retrospective study.
  
  
  CONCLUSIONS
  A standardized EMR (inject-and-cut) technique is a safe and curative treatment option in nonpolypoid colorectal neoplasms (> or = 1 cm) in the United States.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Veterans Affairs Palo Alto Health Care System, Stanford University School of Medicine, Palo Alto, California, USA.
authors.forename: Tonya
authors.initials: T
authors.lastname: Kaltenbach
authors.forename: Shai
authors.initials: S
authors.lastname: Friedland
authors.forename: Anamika
authors.initials: A
authors.lastname: Maheshwari
authors.forename: Daniel
authors.initials: D
authors.lastname: Ouyang
authors.forename: Robert V
authors.initials: RV
authors.lastname: Rouse
authors.forename: Sherry
authors.initials: S
authors.lastname: Wren
authors.forename: Roy
authors.initials: R
authors.lastname: Soetikno
mesh_terms: D000368:Aged; D003111:Colonic Polyps / Q000145:classification / Q000175:diagnosis*; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012449:Safety; D016896:Treatment Outcome