1. Incomplete mucosal layer excision during EMR: a potential source of recurrent adenoma (with video).
- Author
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Tate DJ, Vosko S, Bar-Yishay I, Desomer L, Shahidi N, Sidhu M, McLeod D, and Bourke MJ
- Subjects
- Aged, Female, Humans, Male, Middle Aged, Colonic Polyps surgery, Colonic Polyps pathology, Colonoscopy methods, Colorectal Neoplasms surgery, Colorectal Neoplasms pathology, Neoplasm, Residual, Retrospective Studies, Adenoma surgery, Adenoma pathology, Endoscopic Mucosal Resection methods, Intestinal Mucosa surgery, Intestinal Mucosa pathology, Margins of Excision, Neoplasm Recurrence, Local pathology
- Abstract
Background and Aims: Residual or recurrent adenoma (RRA) detected during surveillance is the major limitation of EMR. The pathogenesis of RRA is unknown, although thermal ablation of the post-endoscopic resection defect (PED) margin reduces RRA. We aimed to identify a feature within the PED that could be associated with RRA., Methods: Between January 2017 and July 2020, detailed prospective procedural data on all EMR procedures performed at a single center were retrospectively analyzed. At the completion of EMR, the PED was systematically examined for features of incomplete mucosal layer excision (IME). This was defined as a demarcated area within the PED bordered by a white electrocautery ring and containing endoscopically identifiable features suggesting incomplete resection of the mucosa including lacy capillaries and/or visible fibers of the muscularis mucosae. Areas of IME were reinjected and re-excised by snare and submitted separately for blinded specialist GI pathologist review., Results: EMR was performed for 508 large nonpedunculated colorectal polyps (LNPCPs) (median size, 35 mm). In 10 PEDs (2.0%), an area of IME was identified and excised. Histopathologic examination of areas of suspected IME demonstrated muscularis mucosae in 9 of 10 (90%), residual lamina propria in 9 of 10 (90.0%), and residual adenoma in 5 of 10 (50.0%). No RRA was detected during follow-up after re-excision of IME., Conclusions: We report the novel finding of IME within the PED after EMR of LNPCPs. IME may contain microscopic residual adenoma and therefore is a risk for RRA during follow-up. After completion of EMR, the PED should be carefully evaluated. If IME is found, it should be excised. (Clinical trial registration number: NCT01368289 and NCT02000141.)., Competing Interests: Disclosure The following author received research support for this study from the Westmead Research Foundation: D. J. Tate. In addition, the following authors disclosed financial relationships: D. J. Tate: Research support from Olympus Medical; consultant for Olympus EMEA. M. J. Bourke: Consultant for Olympus Medical and Boston Scientific. N. Shahidi: Speaker's honoraria from Pharmascience and Boston Scientific. All other authors disclosed no financial relationships. Research support for this study was provided by the Cancer Institute New South Wales, Australia (for a research nurse and data manager to assist with the administration of the study)., (Copyright © 2024 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
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