title: Endoscopic mucosal resection of large rectal adenomas in the era of centralization: Results of a multicenter collaboration.
abstract: OBJECTIVE
  Endoscopic mucosal resection (EMR) of large rectal adenomas is largely being centralized. We assessed the safety and effectiveness of EMR in the rectum in a collaboration of 15 Dutch hospitals.
  
  
  METHODS
  Prospective, observational study of patients with rectal adenomas >3 cm, resected by piecemeal EMR. Endoscopic treatment of adenoma remnants at 3 months was considered part of the intervention strategy. Outcomes included recurrence after 6, 12 and 24 months and morbidity.
  
  
  RESULTS
  Sixty-four patients (50% male, age 69 ± 11, 96% ASA 1/2) presented with 65 adenomas (diameter 46 ± 17 mm, distance ab ano 4.5 cm (IQR 1-8), 6% recurrent lesion). Sixty-two procedures (97%) were technically successful. Histopathology revealed invasive carcinoma in three patients (5%), who were excluded from effectiveness analyses. At 3 months' follow-up, 10 patients showed adenoma remnants. Recurrence was diagnosed in 16 patients during follow-up (recurrence rate 25%). Fifteen of 64 patients (23%) experienced 17 postprocedural complications.
  
  
  CONCLUSIONS
  In a multicenter collaboration, EMR was feasible in 97% of patients. Recurrence and postprocedural morbidity rates were 25% and 23%. Our results demonstrate the outcomes of EMR in the absence of tertiary referral centers.
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Rm
authors.initials: R
authors.lastname: Barendse
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Gd
authors.initials: G
authors.lastname: Musters
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: Fockens
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Wa
authors.initials: W
authors.lastname: Bemelman
authors.affiliation: Department of Surgery, Ijsselland Hospital, Capelle a/d Ijssel, the Netherlands.
authors.forename: Ej
authors.initials: E
authors.lastname: de Graaf
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Fj
authors.initials: F
authors.lastname: van den Broek
authors.affiliation: Department of Gastroenterology and Hepatology, Medical Center Leeuwarden, the Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: van der Linde
authors.affiliation: Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, the Netherlands.
authors.forename: Mp
authors.initials: M
authors.lastname: Schwartz
authors.affiliation: Department of Gastroenterology and Hepatology, Haga Hospital, 's Gravenhage, the Netherlands.
authors.forename: Mh
authors.initials: M
authors.lastname: Houben
authors.affiliation: Department of Gastroenterology and Hepatology, Amphia Hospital, Breda, the Netherlands.
authors.forename: Aw
authors.initials: A
authors.lastname: van Milligen de Wit
authors.affiliation: Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, the Netherlands.
authors.forename: Bj
authors.initials: B
authors.lastname: Witteman
authors.affiliation: Department of Gastroenterology and Hepatology, Ijsselland Hospital, Capelle a/d Ijssel; the Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Winograd
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Dekker
keywords: Rectum; adenoma; endoscopic mucosal resection; morbidity; recurrence