title: Polyp recurrence after endoscopic mucosal resection of sessile and flat colonic adenomas.
abstract: BACKGROUND
  Endoscopic mucosal resection (EMR) is used for treatment of sessile and flat colonic adenomas. There is limited data comparing polyp recurrence between piecemeal and en-bloc resections.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the incidence density and predictive factors for polyp recurrence after piecemeal and en-bloc resections.
  
  
  METHODS
  Patients undergoing EMR of flat or sessile adenomas≥10 mm were included. Incidence density (ID) and incidence rate ratio (IRR) of polyp recurrence were calculated. Predictive factors for recurrence were assessed by multivariate analysis using logistic regression.
  
  
  RESULTS
  A total of 105 patients (males 54, mean age 68) with 121 polyps were included. Sixty-seven polyps (mean size±SD, 23.3±9.2 mm) were resected piecemeal and 54 polyps (mean size 14.7±5.1 mm) were resected en-bloc. There were 12 recurrences in the piecemeal group and two in the en-bloc group. The ID of polyp recurrence in the piecemeal group was 13.1 (95% CI 7.43-23.03) and in the en-bloc group was 2.7 (95% CI 0.67-10.78) per 100 person-years of follow-up. Piecemeal resections were 5.5 (95% CI 1.1-30.48, P=0.045) times and flat polyps were 6.6 (95% CI 1.22-35.53, P=0.028) times more likely to result in recurrence compared to en-bloc resections and sessile polyps, respectively. In the piecemeal group, additional use of argon plasma coagulation (APC) did not affect the recurrence (OR 0.46, P=0.29).
  
  
  CONCLUSIONS
  Piecemeal resections and flat polyps are associated with higher recurrence following EMR. Additional use of APC did not affect the recurrence rates after piecemeal resection.
authors.affiliation: Nottingham Digestive Diseases Centre and NIHR Biomedical Research Unit, Queens Medical Centre Campus, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK.
authors.forename: J
authors.initials: J
authors.lastname: Mannath
authors.forename: V
authors.initials: V
authors.lastname: Subramanian
authors.forename: R
authors.initials: R
authors.lastname: Singh
authors.forename: E
authors.initials: E
authors.lastname: Telakis
authors.forename: K
authors.initials: K
authors.lastname: Ragunath
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D057908:Argon Plasma Coagulation; D003110:Colonic Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D003111:Colonic Polyps / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D003113:Colonoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome