title: Endoscopic resection of subtotal or completely circumferential laterally spreading colonic adenomas: technique, caveats, and outcomes.
abstract: OBJECTIVE
  Endoscopic mucosal resection (EMR) is an established treatment for large (≥ 20 mm) laterally spreading lesions (LSLs). LSLs with complete or subtotal (> 90 %) circumferential extent (C-LSLs) are generally referred for surgery. Data on technique, efficacy, and safety of EMR for these lesions are absent. The aim of this study was to describe the technique and long-term outcomes of EMR for C-LSLs.
  
  
  METHODS
  Prospective observational study of consecutive patients referred for EMR of LSL at a tertiary care center over 63 months to April 2015. Amongst 979 patients with LSL, 12 patients with C-LSL were seen.
  
  
  RESULTS
  All lesions were tubulovillous adenomas with granular 0 - IIa + Is morphology. Median longitudinal extent was 95 mm (range 60 - 160), 58 % were located in the rectum, and 3 lesions (25 %) had complete circumferential involvement. EMR technical success was 100 %. There were no major adverse events. Symptomatic stricturing occurred in 2 cases (17 %) and was treated with endoscopic balloon dilation (median 4 sessions). Median follow up is 13 months. Minor residual adenoma was found in 7 (58 %) at first surveillance colonoscopy and was treated with snare excision. A total of 10 patients have completed a second surveillance colonoscopy with minor residual adenoma found in only 1 case. No patient required surgery or developed cancer in long-term follow-up.
  
  
  CONCLUSIONS
  Endoscopic resection of C-LSL is feasible and safe. Minor residual adenoma is common but endoscopically treatable with long-term cure. Symptomatic stricturing amenable to balloon dilation may occur. Empiric surgical referral for C-LSL based on extensive circumferential involvement may be avoided.ClinicalTrials.gov NCT01368289.
authors.affiliation: Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Tutticci
authors.affiliation: Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia.
authors.forename: Amir
authors.initials: A
authors.lastname: Klein
authors.affiliation: Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Sonson
authors.affiliation: Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bourke
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000601:surgery; D001315:Australia; D003111:Colonic Polyps / Q000473:pathology / Q000601:surgery; D000069916:Endoscopic Mucosal Resection / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology / Q000601:surgery; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D000069451:Long Term Adverse Effects / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D011351:Proctoscopy / Q000009:adverse effects / Q000379:methods; D011446:Prospective Studies; D012007:Rectum / Q000473:pathology / Q000601:surgery; D012720:Severity of Illness Index; D016896:Treatment Outcome