title: Recurrence after endoscopic mucosal resection-therapy failure?
abstract: OBJECTIVE
  To evaluate the success and complication rates of endoscopic mucosal resections (EMR) for large flat adenomas and to identify risk factors for adenoma recurrence.
  
  
  METHODS
  We evaluated all consecutive patients treated with EMR at our institution between 2003 and 2005 that fulfilled the following criteria: >10-mm diameter, Paris 0-Is and 0-IIa-c, and endoscopic follow-up. We conducted univariate analysis and multivariate analysis using a non-stratified logistic regression model to identify possible influencing factors.
  
  
  RESULTS
  In a median follow-up period of 6 years, we analyzed 177 EMR procedures, with a mean size of 21 mm. The majority of the resections were in the right colon. Recurrence occurred in 29 patients. Further treatment of patients with recurrence was endoscopic in 27 patients, whereas 1 patient was treated with transanal endoscopic microsurgery and one underwent surgery. The variables influencing the multivariate model were resection technique, immediate complication age, and histology.
  
  
  CONCLUSIONS
  We show that EMR can achieve a long-term clearance of large flat adenomas. A recurrence after EMR does not equal to failed therapy. The possibility of recurrence has to be considered in the clinical implementation of EMR. An important part of the stratifying factors for follow-up is the procedural assessment of the effectiveness of the resection and the resection technique.
authors.affiliation: University Medical Centre, Mannheim Heidelberg University, Mannheim, Germany, sebastianbelle@me.com.
authors.forename: S
authors.initials: S
authors.lastname: Belle
authors.forename: L
authors.initials: L
authors.lastname: Haase
authors.forename: L R
authors.initials: LR
authors.lastname: Pilz
authors.forename: S
authors.initials: S
authors.lastname: Post
authors.forename: M
authors.initials: M
authors.lastname: Ebert
authors.forename: G
authors.initials: G
authors.lastname: Kaehler
mesh_terms: D000328:Adult; D000368:Aged; D003113:Colonoscopy; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D017211:Treatment Failure; D055815:Young Adult