title: Outcomes of endoscopic treatment of second recurrences of large nonpedunculated colorectal adenomas.
abstract: Piecemeal endoscopic mucosal resection (EMR) of large nonpedunculated colorectal adenomas is associated with significant recurrence rates. After salvage endoscopic treatment of recurrences, there is a significant rate of second recurrences. There is a paucity of data on the efficacy and safety of continued endoscopic treatment after a second recurrence.
  
  
  
  Consecutive patients with recurrent adenomas after initial piecemeal EMR of nonpedunculated colorectal adenomas >2 cm were reviewed. We assessed the feasibility, safety and efficacy of continued endoscopic treatment in these patients.
  
  
  
  Sixty-four patients with 70 recurrent lesions were identified. All were retreated endoscopically. Follow-up colonoscopy (mean interval 6.4 months) was performed on 62/70 lesions (89 %), and a second recurrence was found in 21/62 (34 %). One patient underwent surgery for a circumferential adenoma of the ileocecal valve. The other 20 lesions were treated endoscopically. Follow-up colonoscopy was performed on 15/20 (75 %) and demonstrated a third recurrence in 3/15 (20 %). One was a deep T1 cancer; curative surgery was performed. The other two patients each had one additional endoscopic treatment and both had no recurrence on subsequent colonoscopy. There were two complications: Both were delayed bleeds after treatment of the first recurrence. A mean of 1.3 endoscopic procedures was required to achieve a cure (range 1-3) for recurrent adenomas after piecemeal EMR.
  
  
  
  Endoscopic treatment of patients with second recurrences is safe and effective, but is associated with a significant rate of additional recurrences. Continued endoscopic treatment of patients with multiple recurrences is associated with high cure rates, low complication rates and a low risk of progression to malignancy.
authors.affiliation: Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea.|Department of Gastroenterology, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Hyun Gun
authors.initials: HG
authors.lastname: Kim
authors.affiliation: Department of Gastroenterology, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Sethi
authors.affiliation: Department of Gastroenterology, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Subhas
authors.initials: S
authors.lastname: Banerjee
authors.affiliation: Department of Gastroenterology, Stanford University School of Medicine, Stanford, CA, USA. shai_friedland@yahoo.com.|VA Palo Alto Health Care System, 711 Middlefield Road, Palo Alto, CA, 94301, USA. shai_friedland@yahoo.com.
authors.forename: Shai
authors.initials: S
authors.lastname: Friedland
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D000069916:Endoscopic Mucosal Resection / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D016879:Salvage Therapy; D047368:Tumor Burden
keywords: Colonic polyps; Colonoscopy; Colorectal cancer