Adenoma recurrence after piecemeal colonic EMR is predictable; the Sydney EMR Recurrence Tool.Tate DJ, Desomer L, Klein A, Brown G, Hourigan LF, Lee EY, Moss A, Ormonde D, Raftopoulos S, Singh R, Williams SJ, Zanati S, Byth K, Bourke MJ. Gastrointest Endosc. 2016 Nov 28. [Epub ahead of print]

BACKGROUND AND AIMS:Endoscopic mucosal resection (EMR) is the primary treatment of large laterally spreading colonic lesions (LSL). Residual or recurrent adenoma (RRA) is a major limitation. We aimed to identify a robust method to stratify risk of RRA.METHODS:Prospective multicenter data on consecutive LSL ≥ 20mm removed by piecemeal EMR from eight Australian tertiary centers was included (September 2008 until May 2016).

A logistic regression model for endoscopically determined recurrence (EDR) was created on a randomly selected half of the cohort to yield the Sydney EMR Recurrence Tool (SERT), a 4-point score to stratify the incidence of RRA based on characteristics of the index EMR. SERT was validated on the remainder of the cohort.RESULTS:Analysis was performed on 1178 lesions that underwent first surveillance colonoscopy (SC1) (median 4.9 months, IQR 4.9 to 6.2). EDR was detected in 228 out of 1178 patients (19.4%). LSL size ≥40 mm (OR 2.47, p<.001), intra-procedural bleeding (OR 1.78, p=.024) and high-grade dysplasia (OR 1.72, p=.029) were identified as independent predictors of EDR and allocated scores of 2, 1 and 1, respectively to create SERT. SERT=0 had a negative predictive value of 91.3% for RRA at SC1 and SERT was shown to stratify RRA to specific follow-up intervals using Kaplan Meier curves (Log-Rank p<.001).CONCLUSIONS:Guidelines recommend SC1 within 6 months of EMR. SERT accurately stratifies the incidence of RRA post EMR. SERT=0 lesions could safely undergo first surveillance at 18 months, whereas SERT 1-4 lesions require surveillance at 6 and 18 months. Leggi l'articolo

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