title: Endoscopic mucosal resection in high- and low-volume centers: a prospective multicentric study.
abstract: BACKGROUND
  Endoscopic mucosal resection (EMR) is an effective therapeutic technique well-standardized worldwide for the treatment of gastrointestinal neoplasm limited to the mucosal layer. To date, no study has compared technical and clinical differences based on the number of EMRs performed per year. This study aimed to compare EMR technical success, complications, and clinical outcome between low-volume centers (LVCs) and high-volume centers (HVCs). A total of nine endoscopic centers were included in the study.
  
  
  METHODS
  This prospective study investigated consecutive patients with sessile polyps or flat colorectal lesions 1 cm or larger referred for EMR.
  
  
  RESULTS
  A total of 427 lesions were resected in 384 patients at nine endoscopic centers. Males accounted for 60.4% and females for 39.6% of the patients. Most of the EMRs (84.8%) were performed in HVCs and only 15.2% in LVCs. All the lesions were resected in only one session. Argon plasma coagulation was performed on the margins of piecemeal resection in 15.7% of the patients in HVCs only. Complete excision was achieved for 98.6% of the lesions in HVCs and 98.8% of the lesions in LVCs. The complication rate was 4.4% in HVCs and 4.6% in LVCs (p = 0.94). Delayed bleeding occurred in 2.5% of the HVC cases and 3.1% of the LVC cases. Perforation occurred in 1.9% of the HVC cases and 1.5% of the LVC cases (p = 1.00). Recurrences were experienced with 15% of the lesions: 15.5% in HVCs and 14% in LVCs (p = 0.79).
  
  
  CONCLUSIONS
  The study showed that EMR can be performed also in LVC.
authors.affiliation: Gastrointestinal Endoscopy, Azienda Ospedaliera San Paolo, University Hospital, University of Milan, Via A. di Rudinì 8, 20142, Milan, Italy, enzo.masci@ao-sanpaolo.it.
authors.forename: E
authors.initials: E
authors.lastname: Masci
authors.forename: E
authors.initials: E
authors.lastname: Viale
authors.forename: C
authors.initials: C
authors.lastname: Notaristefano
authors.forename: B
authors.initials: B
authors.lastname: Mangiavillano
authors.forename: G
authors.initials: G
authors.lastname: Fiori
authors.forename: C
authors.initials: C
authors.lastname: Crosta
authors.forename: M
authors.initials: M
authors.lastname: Dinelli
authors.forename: M
authors.initials: M
authors.lastname: Maino
authors.forename: P
authors.initials: P
authors.lastname: Viaggi
authors.forename: F
authors.initials: F
authors.lastname: Della Giustina
authors.forename: V
authors.initials: V
authors.lastname: Teruzzi
authors.forename: G
authors.initials: G
authors.lastname: Grasso
authors.forename: G
authors.initials: G
authors.lastname: Manes
authors.forename: S
authors.initials: S
authors.lastname: Zambelli
authors.forename: P A
authors.initials: PA
authors.lastname: Testoni
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D000236:Adenoma / Q000601:surgery; D000368:Aged; D003111:Colonic Polyps / Q000601:surgery; D003113:Colonoscopy / Q000379:methods* / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000601:surgery*; D004396:Coloring Agents; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D007203:Indigo Carmine; D007413:Intestinal Mucosa / Q000601:surgery*; D007417:Intestinal Polyps / Q000601:surgery*; D007558:Italy; D018442:Lymphoma, B-Cell, Marginal Zone / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D019106:Postoperative Hemorrhage / Q000209:etiology; D011446:Prospective Studies; D013531:Surgicenters / Q000706:statistics & numerical data*; D016526:Workload
chemical_list: D004396:Coloring Agents; D007203:Indigo Carmine