David J. Tate

A standardized imaging protocol is accurate in detecting recurrence after EMR

BACKGROUND AND AIMSnEMR of large laterally spreading lesions (LSL) in the colon is a safe and effective alternative to surgery. Post-EMR scar assessment currently involves taking biopsy specimens of the scar to detect residual or recurrent adenoma (RRA). The accuracy of endoscopic imaging of the post-EMR scar is unknown. We aimed to determine the accuracy of a standardized imaging protocol in post-EMR scar assessment.nnnMETHODSnProspective, single-center data from the Australian Colonic EMR study were analyzed. Consecutive patients undergoing first surveillance colonoscopy (SC1) after EMR of a large LSL were eligible. All scars were sequentially examined with high-definition white light (HD-WL) and narrow-band imaging (NBI) in a standardized fashion and then biopsies were performed. Endoscopic recurrence (recurrence at the post-EMR scar detected by systematic endoscopic assessment) was compared with the histologic findings.nnnRESULTSnOne hundred eighty-three post-EMR scars were included. Thirty of 183 (16.4%) were confirmed to have RRA histologically at SC1. Thirty-seven of 183 (20.2%) post-EMR scars demonstrated RRA endoscopically. The sensitivity and specificity of endoscopic RRA detection were 93.3% (95% confidence interval [CI], 77.9%-99.2%) and 94.1% (95% CI, 89.1%-97.3%), respectively. The positive predictive value was 75.7% (95% CI, 58.8%-88.2%) and the negative predictive value was 98.6% (95% CI, 95.1%-99.8%). The diagnostic accuracy was 94.0%. Sensitivity was higher for the combination of HD-WL and NBI as opposed to HD-WL alone (93.3% vs 66.7%). The specificity was high for both HD-WL and HD-WLxa0+ NBI (96.1% and 94.1%, respectively). Flat morphology of RRA was better seen with NBI (Pxa0= .002).nnnCONCLUSIONSnEndoscopic detection of RRA in the post-EMR scar is highly accurate using a standardized imaging protocol with HD-WL and NBI. This allows real-time, accurate detection of recurrence and its concurrent treatment, and raises the possibility that routine biopsy of the post-EMR scar may not be necessary.

Endoscopic resection of large duodenal and papillary lateral spreading lesions is clinically and economically advantageous compared with surgery

Background and study aimsu2002Adenomas of the duodenum and ampulla are uncommon. For lesions ≤u200a20u200amm in size and confined to the papillary mound, endoscopic resection is well supported by systematic study. However, for large laterally spreading lesions of the duodenum or papilla (LSL-D/P), surgery is often performed despite substantial associated morbidity and mortality. We aimed to compare actual endoscopic outcomes of such lesions and costs with those predicted for surgery using validated prediction tools. Patients and methodsu2002Patients who underwent endoscopic resection of LSL-D/P were analyzed. Two surgeons assigned the hypothetical surgical management. The National Surgical Quality Improvement Program (NSQIP), and the Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM) were used to predict morbidity, mortality, and length of hospital stay. Actual endoscopic and hypothetical surgical outcomes and costs were compared. Resultsu2002A total of 102 lesions were evaluated (mean age of patients 69 years, 52u200a% male, mean lesion size 40u200amm). Complete endoscopic resection was achieved in 93.1u200a% at the index procedure. Endoscopic adverse events occurred in 18.6u200a%. Recurrence at first surveillance endoscopy was seen in 17.7u200a%. For patients with ≥u200a2 surveillance endoscopies (nu200a=u200a55), 90u200a% were clear of disease and considered cured (median follow-up 27 months). Compared with hypothetical surgical resection, endoscopic resection had less morbidity (18u200a% vs. 31u200a%; Pu200a=u200a0.001) and shorter hospital stay (median 1 vs. 4.75 days; Pu200a<u200a0.001), and was less costly than surgery (mean

The clinical significance and synchronous polyp burden of large (≥ 20 mm) sessile serrated polyps in patients without serrated polyposis syndrome

u200a11u200a093 vs.

394 Endoscopic Mucosal Resection of Laterally Spreading Lesions Around or Involving the Appendiceal Orifice (PA LSLs): Technique, Risk Factors for Failure and Outcomes of a Tertiary Referral Cohort

u200a19u200a358; Pu200a<u200a0.001). Conclusionu2002In experienced centers, even extensive LSL-D/P can be managed endoscopically with favorable morbidity and mortality profiles, and reduced costs, compared with surgery.

1002 A Standardized Imaging Protocol Is Accurate in Detecting Recurrence After Endoscopic Mucosal Resection

BACKGROUNDnSessile serrated polyps (SSPs) are important precursors of colorectal carcinoma and interval cancer. Large SSPs (≥u200a20u200amm) outside the definition of serrated polyposis syndrome (SPS) have not been studied in comparison with SPS. We aimed to describe the characteristics of patients with large SSPs in this context.nnnMETHODSnPatients with at least one SSP (≥u200a20u200amm) were eligible. Data from three consecutive colonoscopies were used to compare clinical and endoscopic characteristics in three patient groups: SPS, a solitary large SSP, and patients with at least two SSPs without fulfilling the criteria for SPS (oligo-SSP). Data on the diagnostic colonoscopy were collected retrospectively, whereas the remaining data was collected prospectively.nnnRESULTSn67/146 patients (45.9u200a%) had SPS, 53/146 (36.3u200a%) had a solitary SSP, and 26/146 (17.8u200a%) were categorized as oligo-SSP. Personal (16.4u200a%, 9.4u200a%, and 11.5u200a%, respectively) and family (17.9u200a%, 17.0u200a%, and 23.1u200a%, respectively) history of colorectal carcinoma did not differ significantly between groups. Polyp burden was greater in SPS compared with solitary SSP but was not different from oligo-SSP (advanced adenomas: SPS 32.8u200a% vs. solitary SSP 9.4u200a% [Pu200a=u200a0.002] vs. oligo-SSP 34.6u200a% [Pu200a=u200a0.87]; ≥u200a10 conventional adenomas: 11.9u200a% vs. 0u200a% [Pu200a=u200a0.01] vs. 3.8u200a% [Pu200a=u200a0.44], respectively). Dysplasia in large SSPs was frequent in all groups (41.1u200a% overall). SPS was recognized by referring endoscopists in only 9.0u200a% of cases.nnnCONCLUSIONnPatients with oligo-SSPs have similar synchronous polyp burden and clinical characteristics as patients with SPS and may require similar surveillance. Modification of the criteria for the diagnosis of SPS to include this group seems warranted. Patients with a solitary SSP have a lower risk of synchronous polyps, including advanced adenomas. Larger studies are warranted to determine whether these patients may return to standard surveillance following complete examination and clearance of the colon.