Risk factors for incomplete resection and complications in endoscopic mucosal resection for lateral spreading tumors.
OBJECTIVE
Lateral spreading tumors (LST) are relatively large flat lesions with diameters exceeding 10 mm in length. Endoscopic mucosal resection (EMR) is a commonly used technique for removing LST. We aimed to evaluate the risk factors for incomplete resection and complications of EMR for LST.


METHODS
Between January 2004 and December 2010, 497 patients who underwent EMR for LST were retrospectively reviewed. Risk factors for endoscopic and histopathological complete resection, complications, and clinical outcomes were investigated.


RESULTS
Risks for incomplete resection by piecemeal resection and en bloc resection of a lesion ≥ 30 mm were higher than for en bloc resection of a lesion <30 mm (OR=2.688, CI 1.036-6.993; OR=4.982, CI 1.894-13.101). Risks of post-EMR bleeding for piecemeal resection and en bloc resection for a lesion ≥ 40 mm were higher than for en bloc resection of a lesion <40 mm (OR=15.231, CI 1.816-127.744; OR=43.043, CI 4.306-430.314).


CONCLUSIONS
We found risk factors of EMR for LST and tentatively suggest a protocol for EMR adapted to the size of LST and resection methods. (i) Following piecemeal resection and en bloc resection for LST ≥ 40 mm, hospitalize patients for 36 h and note risk for incomplete resection and delayed bleeding. (ii) After en bloc resection for 40 mm>LST ≥ 30 mm, hospitalize patients for 12 h and note risk for incomplete resection. (iii) Following en bloc resection for LST<30 mm, hospitalize the patient for 12 h and expect complete resection.
Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea. drhhkim@gmail.com
Hyung Hun
HH
Kim
Joo Hoon
JH
Kim
Seun Ja
SJ
Park
Moo In
MI
Park
Won
W
Moon
D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D003106:Colon / Q000473:pathology; D003110:Colonic Neoplasms / Q000473:pathology* / Q000601:surgery*; D003113:Colonoscopy; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa; D007431:Intraoperative Complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure