title: Clinical utility of the SMSA grading tool for the management of colonic neoplastic lesions.
abstract: BACKGROUND
  Whilst polyp size has been traditionally used as a predictor of the complexity of endoscopic resection, the influence of other factors is increasingly recognised. The SMSA grading system takes into account polyp Site, Morphology, Size and Access, with higher scores correlating with increased technical difficulty.
  
  
  OBJECTIVE
  To evaluate whether the SMSA grading tool correlates with endoscopic and clinical outcomes.
  
  
  METHODS
  This retrospective study was conducted at two high volume centres in the United Kingdom and Italy. All polyps identified at colonoscopy were included in this study and classified as per the SMSA grading system.
  
  
  RESULTS
  A total of 1668 lesions were resected in 1016 patients. There was a positive correlation between increasing SMSA level and the inability to resect lesions "en bloc" (p<0.001). Histologically complete clearance was higher in the lower SMSA groups (p<0.0001). Additional endoscopic therapies, were more commonly required with the higher SMSA groups to achieve histological clearance (p<0.0001). Moreover, advanced histology in resection specimens and procedural complications were significantly less common in SMSA level 1 lesions compared to level 3 or 4 lesions (p<0.0001).
  
  
  CONCLUSIONS
  The SMSA grading tool is a useful predictor of outcome following the resection of colonic neoplastic lesions.
authors.affiliation: Gastroenterology, Hospital Maresca, ASLNA3sud, Torre del Greco, Italy; NIHR Nottingham Digestive Diseases Biomedical Research Unit, Queens Medical Centre, Nottingham University Hospitals NHS Trust, UK. Electronic address: sansone.stefano@gmail.com.
authors.forename: Stefano
authors.initials: S
authors.lastname: Sansone
authors.affiliation: NIHR Nottingham Digestive Diseases Biomedical Research Unit, Queens Medical Centre, Nottingham University Hospitals NHS Trust, UK.
authors.forename: Krish
authors.initials: K
authors.lastname: Ragunath
authors.affiliation: Gastroenterology, Hospital Maresca, ASLNA3sud, Torre del Greco, Italy.
authors.forename: Maria Antonia
authors.initials: MA
authors.lastname: Bianco
authors.affiliation: Gastroenterology, Cardarelli Hospital, Napoli, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Manguso
authors.affiliation: NIHR Nottingham Digestive Diseases Biomedical Research Unit, Queens Medical Centre, Nottingham University Hospitals NHS Trust, UK.
authors.forename: Sabina
authors.initials: S
authors.lastname: Beg
authors.affiliation: NIHR Nottingham Digestive Diseases Biomedical Research Unit, Queens Medical Centre, Nottingham University Hospitals NHS Trust, UK.
authors.forename: Abhay
authors.initials: A
authors.lastname: Bagewadi
authors.affiliation: Derby Teaching Hospitals, NHS Foundation Trust, UK.
authors.forename: Said
authors.initials: S
authors.lastname: Din
authors.affiliation: Gastroenterology, Hospital Maresca, ASLNA3sud, Torre del Greco, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Rotondano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003111:Colonic Polyps / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery*; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000473:pathology*; D005260:Female; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D006113:United Kingdom
keywords: Endoscopic resection; Polyp; Polypectomy; SMSA; Score