Original Article

Endoscopic Mucosal Resection Recurrence Rate for Colorectal Lesions

Authors: Arleen M. Ortiz, MD, Patham Bhargavi, MD, PhD, Marc J. Zuckerman, MD, Mohamed O. Othman, MD

Abstract

Objectives: We aimed to evaluate the polyp recurrence rate after endoscopic mucosal resection (EMR) and factors contributing to increased recurrence.

Methods: MEDLINE (from 1966 to 2013), the Cochrane Central Register of Controlled Trials, and the Scopus database were searched in December 2013. Studies evaluating the polyp recurrence rate after colonic EMR were included. All of the articles were assigned a quality score. Standard forms were used to extract data regarding study design, outcome measures, and adverse effects by two independent reviewers. We performed a meta-analysis with a random effects model. Separate analyses were performed for each main outcome by using odds ratio (OR) and risk difference. Heterogeneity was assessed by I 2 measure of inconsistency.

Results: For the recurrence rate of colorectal lesions, 30 articles were included, with a total of 3404 patients. The polyp recurrence rate after EMR was 13.1%. Piecemeal resection was associated with a higher recurrence rate compared with en bloc resection (OR 4.39, 95% confidence interval 2.05–9.41; 14 studies). The use of argon plasma coagulation did not affect the polyp recurrence rate (OR 1.23, 95% confidence interval 0.39–3.88). Significant heterogeneity was present among studies.

Conclusions: The recurrence rate of colorectal polyps after EMR is reasonably low; however, piecemeal resection was associated with a higher recurrence rate than en bloc resection after EMR.

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References

1. American Cancer Society. Cancer facts and figures 2011. http://www.cancer.org/research/cancerfactsfigures/cancerfactsfigures/cancer-facts-figures-2011. Accessed January 9, 2013.
 
2. Poppers DM, Haber GB. Endoscopic mucosal resection of colonic lesions: current applications and future prospects. Med Clin North Am 2008;92:687-705.
 
3. Soetikno RM, Gotoda T, Nakanishi Y, et al. Endoscopic mucosal resection. Gastrointest Endosc 2003;57:567-579.
 
4. Larghi A, Waxman I. Endoscopic mucosal resection: treatment of neoplasia. Gastrointest Endosc Clin N Am 2005;15:431-454.
 
5. Pech O, May A, Gossner L, et al. Management of pre-malignant and malignant lesions by endoscopic resection. Best Pract Res Clin Gastroenterol 2004;18:61-76.
 
6. Conio M. Endoscopic mucosal resection. Gastroenterol Hepatol (N Y) 2011;7:248-250.
 
7. Tada M, Tamekoto T. The development of "strip-off" biopsy. Gastroenterol Endosc 1984;26:833-836.
 
8. Larghi A, Waxman I. State of the art on endoscopic mucosal resection and endoscopic submucosal dissection. Gastrointest Endosc Clin N Am 2007;17:441-469.
 
9. Kanamori T, Itoh M, Yokoyama Y, et al. Injection-incisionYassisted snare resection of large sessile colorectal polyps. Gastrointest Endosc 1996;43:189-195.
 
10. Waye JD. Endoscopic mucosal resection of colon polyps. Gastrointest Endosc Clin N Am 2001;11:537-548.
 
11. Huang Y, Liu S, Gong W, et al. Clinicopathologic features and endoscopic mucosal resection of laterally spreading tumors: experience from China. Int J Colorectal Dis 2009;24:1441-1450.
 
12. ASGE Technology Committee, Kantsevoy SV, Adler DG, et al. Endoscopic mucosal resection and endoscopic submucosal dissection. Gastrointest Endosc 2008;68:11-18.
 
13. Zlatanic J, Waye JD, Kim PS, et al. Large sessile colonic adenomas: use of argon plasma coagulator to supplement piecemeal snare polypectomy. Gastrointest Endosc 1999;49:731-735.
 
14. Santos CE, Malaman D, Pereira-Lima JC. Endoscopic mucosal resection in colorectal lesion: a safe and effective procedure even in lesions larger than 2 cm and in carcinomas. Arq Gastroenterol 2011;48:242-247.
 
15. Conio M, Ponchon T, Blanchi S, et al. Endoscopic mucosal resection. Am J Gastroenterol 2006;101:653-663.
 
16. Park JJ, Cheon JH, Kwon JE, et al. Clinical outcomes and factors related to resectability and curability of EMR for early colorectal cancer. Gastrointest Endosc 2011;74:1337-1346.
 
17. Tamegai Y, Saito Y, Masaki N, et al. Endoscopic submucosal dissection: a safe technique for colorectal tumors. Endoscopy 2007;39:418-422.
 
18. Terasaki M, Tanaka S, Oka S, et al. Clinical outcomes of endoscopic submucosal dissection and endoscopic mucosal resection for laterally spreading tumors larger than 20 mm. J Gastroenterol Hepatol 2012;27:734-740.
 
19. Ah Soune P, Menard C, Salah E, et al. Large endoscopic mucosal resection for colorectal tumors exceeding 4 cm. World J Gastroenterol 2010;16:588-595.
 
20. Tanaka S, Haruma K, Oka S, et al. Clinicopathologic features and endoscopic treatment of superficially spreading colorectal neoplasms larger than 20 mm. Gastrointest Endosc 2001;54:62-66.
 
21. Mannath J, Subramanian V, Singh R, et al. Polyp recurrence after endoscopic mucosal resection of sessile and flat colonic adenomas. Dig Dis Sci 2011;56:2389-2395.
 
22. Buchner AM, Guarner-Argente C, Ginsberg GG. Outcomes of EMR of defiant colorectal lesions directed to an endoscopy referral center. Gastrointest Endosc 2012;76:255-263.
 
23. Lim TR, Mahesh V, Singh S, et al. Endoscopic mucosal resection of colorectal polyps in typical UK hospitals. World J Gastroenterol 2010;16:5324-5328.
 
24. Kobayashi N, Yoshitake N, Hirahara Y, et al. Matched case-control study comparing endoscopic submucosal dissection and endoscopic mucosal resection for colorectal tumors. J Gastroenterol Hepatol 2012;27:728-733.
 
25. Barendse RM, van den Broek FJ, van Schooten J, et al. Endoscopic mucosal resection vs transanal endoscopic microsurgery for the treatment of large rectal adenomas. Colorectal Dis 2012;14:e191-e196.
 
26. Luigiano C, Consolo P, Scaffidi MG, et al. Endoscopic mucosal resection for large and giant sessile and flat colorectal polyps: a single-center experience with long-term follow-up. Endoscopy 2009;41:829-835.
 
27. Ferrara F, Luigiano C, Ghersi S, et al. Efficacy, safety and outcomes of "inject and cut" endoscopic mucosal resection for large sessile and flat colorectal polyps. Digestion 2010;82:213-220.
 
28. Seo GJ, Sohn DK, Han KS, et al. Recurrence after endoscopic piecemeal mucosal resection for large sessile colorectal polyps. World J Gastroenterol 2010;16:2806-2811.
 
29. Woodward TA, Heckman MG, Cleveland P, et al. Predictors of complete endoscopic mucosal resection of flat and depressed gastrointestinal neoplasia of the colon. Am J Gastroenterol 2012;107:650-654.
 
30. Arezzo A, Pagano N, Romeo F, et al. Hydroxy-propyl-methyl-cellulose is a safe and effective lifting agent for endoscopic mucosal resection of large colorectal polyps. Surg Endosc 2009;23:1065-1069.
 
31. Kikuchi R, Takano M, Takagi K, et al. Management of early invasive colorectal cancer. Risk of recurrence and clinical guidelines. Dis Colon Rectum 1995;38:1286-1295.
 
32. Tamura S, Nakajo K, Yokoyama Y, et al. Evaluation of endoscopic mucosal resection for laterally spreading rectal tumors. Endoscopy 2004;36:306-312.
 
33. Hochdörffer R, Eickhoff A, Apel D, et al. Endoscopic resection of "giant" colorectal lesions: long-term outcome and safety. Z Gastroenterol 2010;48:741-747.
 
34. Arebi N, Swain D, Suzuki N, et al. Endoscopic mucosal resection of 161 cases of large sessile or flat colorectal polyps. Scand J Gastroenterol 2007;42:859-866.
 
35. Jameel JK, Pillinger SH, Moncur P, et al. Endoscopic mucosal resection (EMR) in the management of large colorectal polyps. Colorectal Dis 2006;8:497-500.
 
36. Martinez ME, Baron JA, Lieberman DA, et al. A pooled analysis of advanced colorectal neoplasia diagnoses after colonoscopic polypectomy. Gastroenterology 2009;136:832-841.
 
37. Regula J, Wronska E, Polkowski M, et al. Argon plasma coagulation after piecemeal polypectomy of sessile colorectal adenomas: long-term follow-up study. Endoscopy 2003;35:212-218.
 
38. Brooker JC, Saunders BP, Shah SG, et al. Treatment with argon plasma coagulation reduces recurrence after piecemeal resection of large sessile colonic polyps: a randomized trial and recommendations. Gastrointest Endosc 2002;55:371-375.
 
39. Bories E, Pesenti C, Monges G, et al. Endoscopic mucosal resection for advanced sessile adenoma and early-stage colorectal carcinoma. Endoscopy 2006;38:231-235.
 
40. Lieberman DA, Rex DK, Winawer SJ, et al. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2012;143:844-857.
 
41. Levin B, Lieberman DA, McFarland B, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin 2008;58:130-160.
 
42. Martinez ME, Thompson P, Messer K, et al. One-year risk for advanced colorectal neoplasia: U.S. versus U.K. risk-stratification guidelines. Ann Intern Med 2012;157:856-864.
 
43. Cairns SR, Scholefield JH, Steele RJ, et al. Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002). Gut 2010;59:666-689.
 
44. Robertson DJ, Lieberman DA, Winawer SJ, et al. Colorectal cancers soon after colonoscopy: a pooled multicohort analysis. Gut 2014;63:949-956.
 
45. Cao Y, Liao C, Tan A, et al. Meta-analysis of endoscopic submucosal dissection versus endoscopic mucosal resection for tumors of the gastrointestinal tract. Endoscopy 2009;41:751-757.
 
46. Puli SR, Kakugawa Y, Gotoda T, et al. Meta-analysis and systematic review of colorectal endoscopic mucosal resection. World J Gastroenterol 2009;15:4273-4277.
 
47. Tajika M, Niwa Y, Bhatia V, et al. Comparison of endoscopic submucosal dissection and endoscopic mucosal resection for large colorectal tumors. Eur J Gastroenterol Hepatol 2011;23:1042-1049.
 
48. Sakamoto T, Matsuda T, Nakajima T, et al. Efficacy of endoscopic mucosal resection with circumferential incision for patients with large colorectal tumors. Clin Gastroenterol Hepatol 2012;10:22-26.
 
49. Doniec JM, Löhnert MS, Schniewind B, et al. Endoscopic removal of large colorectal polyps: prevention of unnecessary surgery? Dis Colon Rectum 2003;46:340-348.