title: Endoscopic mucosal resection for large serrated lesions in comparison with adenomas: a prospective multicentre study of 2000 lesions.
abstract: Endoscopic mucosal resection (EMR) is effective for large laterally spreading flat and sessile lesions (LSLs). Sessile serrated adenomas/polyps (SSA/Ps) are linked to the relative failure of colonoscopy to prevent proximal colorectal cancer. We aimed to examine the technical success, adverse events and recurrence following EMR for large SSA/Ps in comparison with large conventional adenomas.
  
  
  
  Over 74 months till August 2014, prospective multicentre data of LSLs ≥20 mm were analysed. A standardised dye-based conventional EMR technique followed by scheduled surveillance colonoscopy was used.
  
  
  
  From a total of 2000 lesions, 323 SSA/Ps in 246 patients and 1527 adenomas in 1425 patients were included for analysis. Technical success for EMR was superior in SSA/Ps compared with adenomas (99.1% vs 94.5%, p<0.001). Significant bleeding and perforation were similar in both cohorts. The cumulative recurrence rates for adenomas after 6, 12, 18 and 24 months were 16.1%, 20.4%, 23.4% and 28.4%, respectively. For SSA/Ps, they were 6.3% at 6 months and 7.0% from 12 months onwards (p<0.001). Following multivariable adjustment, the HR of recurrence for adenomas versus SSA/Ps was 1.7 (95% CI 0.9 to 3.0, p=0.097). Subgroup analysis by lesion size revealed an eightfold increased risk of recurrence for 20-25 mm adenomas versus SSA/Ps, but no significantly different risk between lesion types in larger lesion groups.
  
  
  
  Recurrence after EMR of 20-25 mm LSLs is significantly less frequent in SSA/Ps compared with adenomatous lesions. SSA/Ps can be more effectively removed than adenomatous LSLs with equivalent safety. Ensuring complete initial resection is imperative for avoiding recurrence.
  
  
  
  ClinicalTrials.gov NCT01368289.
authors.affiliation: Departments of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Maria
authors.initials: M
authors.lastname: Pellise
authors.affiliation: Departments of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia.|Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Burgess
authors.affiliation: Departments of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Tutticci
authors.affiliation: Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.|Department of Gastroenterology and Hepatology, Greenslopes Private Hospital, Brisbane, Queensland, Australia.
authors.forename: Luke F
authors.initials: LF
authors.lastname: Hourigan
authors.affiliation: Department of Gastroenterology and Hepatology, The Alfred Hospital, Melbourne, Victoria, Australia.|Department of Gastroenterology and Hepatology, Western Hospital, Melbourne, Victoria, Australia.
authors.forename: Simon A
authors.initials: SA
authors.lastname: Zanati
authors.affiliation: Department of Gastroenterology and Hepatology, The Alfred Hospital, Melbourne, Victoria, Australia.|Department of Gastroenterology and Hepatology, Epworth Hospital, Melbourne, Victoria, Australia.
authors.forename: Gregor J
authors.initials: GJ
authors.lastname: Brown
authors.affiliation: Department of Gastroenterology and Hepatology, Lyell McEwin Hospital, Adelaide, South Australia, Australia.
authors.forename: Rajvinder
authors.initials: R
authors.lastname: Singh
authors.affiliation: Departments of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Williams
authors.affiliation: Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
authors.forename: Spiro C
authors.initials: SC
authors.lastname: Raftopoulos
authors.affiliation: Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
authors.forename: Donald
authors.initials: D
authors.lastname: Ormonde
authors.affiliation: Department of Gastroenterology and Hepatology, Western Hospital, Melbourne, Victoria, Australia.
authors.forename: Alan
authors.initials: A
authors.lastname: Moss
authors.affiliation: NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia.|Research and Education Network, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Byth
authors.affiliation: Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Heok
authors.initials: H
authors.lastname: P'Ng
authors.affiliation: Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Hema
authors.initials: H
authors.lastname: Mahajan
authors.affiliation: Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Duncan
authors.initials: D
authors.lastname: McLeod
authors.affiliation: Departments of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia.|Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bourke
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000359:Aftercare; D000367:Age Factors; D000368:Aged; D016063:Blood Loss, Surgical; D003111:Colonic Polyps / Q000473:pathology / Q000601:surgery*; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D000069916:Endoscopic Mucosal Resection / Q000009:adverse effects; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D018365:Neoplasm, Residual; D019106:Postoperative Hemorrhage / Q000209:etiology*; D011446:Prospective Studies; D017211:Treatment Failure; D047368:Tumor Burden
keywords: COLONIC POLYPS; COLONOSCOPY; COLORECTAL ADENOMAS; COLORECTAL CANCER; ENDOSCOPIC PROCEDURES