title: Outcome and risk of recurrence for endoscopic resection of colonic superficial neoplastic lesions over 2 cm in diameter.
abstract: BACKGROUND
  Large colorectal superficial neoplastic lesions are challenging to remove. This study aimed to assess the outcomes of routine endoscopic resection of large (≥2 cm and <3 cm) and giant (≥3 cm) lesions.
  
  
  METHODS
  From 4587 endoscopic resections, 265 (5.7%) large and giant lesions were removed in 249 patients. We retrospectively analyzed 125 patients (141 endoscopic mucosal resection, 73 large and 68 giant lesions) with a follow-up of 6-12 months. Rate of en bloc and piecemeal resection, recurrence and risk factors were analyzed.
  
  
  RESULTS
  En bloc was performed in 92 cases (65.2%) and piecemeal resection in 49 (34.8%). A complete endoscopic resection was achieved in 139 cases (98.5%) with radical resection in 84/139 cases (60.4%). Argon plasma coagulation was applied in 18/141 lesions (12.8%). A recurrence occurred in 16/139 lesions (11.5%). The risk of recurrence at one year was significantly higher for giant than large lesions (p=0.03). The recurrence risk was higher in treated than in non-argon plasma coagulation treated lesions (p=0.01).
  
  
  CONCLUSIONS
  endoscopic mucosal resection is a safe and effective routine treatment for large superficial neoplastic lesions. The risk factors for recurrence include giant size, non-protruding morphology, piecemeal technique and argon plasma coagulation.
authors.affiliation: Department of Gastroenterology and Digestive Endoscopy, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Margagnoni
authors.affiliation: Department of Gastroenterology and Digestive Endoscopy, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Angeletti
authors.affiliation: Department of Gastroenterology and Digestive Endoscopy, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: D'Ambra
authors.affiliation: Department of Gastroenterology and Digestive Endoscopy, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Cristiano
authors.initials: C
authors.lastname: Pagnini
authors.affiliation: Department of Gastroenterology and Digestive Endoscopy, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Ruggeri
authors.affiliation: Department of Gastroenterology and Digestive Endoscopy, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy. Electronic address: vito.corleto@uniroma1.it.
authors.forename: Vito Domenico
authors.initials: VD
authors.lastname: Corleto
authors.affiliation: Department of Gastroenterology and Digestive Endoscopy, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Emilio
authors.initials: E
authors.lastname: Di Giulio
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057908:Argon Plasma Coagulation; D003111:Colonic Polyps / Q000473:pathology* / Q000601:surgery; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: En block; Endoscopic mucosa resection; Piecemeal; Polyps; Superficial neoplastic lesions