Optimizing endoscopic resection for challenging large non-pedunculated colorectal polyps
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Open Access
Type
ThesisThesis type
Doctor of PhilosophyAuthor/s
Shahidi, Neal CinaAbstract
Endoscopic mucosal resection (EMR) has revolutionized the management of large (≥ 20mm) non-pedunculated colorectal polyps. However, there are still challenges in performing EMR. Our aim was to assess EMR outcomes for challenging LNPCPs using the Australian Colonic Endoscopic Resection ...
See moreEndoscopic mucosal resection (EMR) has revolutionized the management of large (≥ 20mm) non-pedunculated colorectal polyps. However, there are still challenges in performing EMR. Our aim was to assess EMR outcomes for challenging LNPCPs using the Australian Colonic Endoscopic Resection (ACE) study, a prospective multicenter observational cohort. No difference in technical success or recurrence were identified between LNPCPs at the anorectal junction (ARJ-LNPCPs) and large non-pedunculated rectal polyps. No recurrence was identified at first surveillance colonoscopy (SC1; 0.0% vs. 25.0%; p=0.002) amongst 30 ARJ-LNPCPs treated by EMR with margin thermal ablation (EMR-T) vs. those that did not. Comparing a universal EMR algorithm (UEA) and a selective resection algorithm (SRA), significant differences in cancer after EMR (SRA 1 (1.0%) vs. UEA 35 (12.1%); p = 0.001), and curative oncologic resection (SRA 7 (33.3%) vs. UEA 2 (5.7%); p = 0.010) were identified. Significant differences in resection duration (35 minutes vs. 25 minutes; p<0.001) technical success (93.0% vs. 96.6%; p=0.026) and use of adjuvant modalities (46.2% vs. 7.6%; p<0.001), were identified between previously attempted LNPCPs (PA-LNPCPs) and naïve LNPCPs. Recurrence was not identified in 65 PA-LNPCPs which underwent EMR-T at SC1 vs. 9 (18.0%; p<0.001) which did not. Significant deep mural injury (S-DMI) occurred in 101 cases (2.7%) which underwent EMR. Successful defect closure was achieved in 98 (97.0%). No difference in technical success (94 (93.1%) vs. 3316 (91.7%) p = 0.62) or SC1 recurrence (12 (20.0%) vs. 363 (13.6%); p = 0.15) were identified between LNPCPs with and without S-DMI. Significant differences in sensitivity (90.9% vs. 52.7%), specificity (96.3% vs. 93.7%) and SMIC miss rate (0.6% vs. 5.9%) between flat and nodular LNPCPs were identified (all p < 0.027). Multiple logistic regression identified nodular morphology (OR 7.2; 95%CI 2.8-18.9) as a predictor of missed cancer.
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See moreEndoscopic mucosal resection (EMR) has revolutionized the management of large (≥ 20mm) non-pedunculated colorectal polyps. However, there are still challenges in performing EMR. Our aim was to assess EMR outcomes for challenging LNPCPs using the Australian Colonic Endoscopic Resection (ACE) study, a prospective multicenter observational cohort. No difference in technical success or recurrence were identified between LNPCPs at the anorectal junction (ARJ-LNPCPs) and large non-pedunculated rectal polyps. No recurrence was identified at first surveillance colonoscopy (SC1; 0.0% vs. 25.0%; p=0.002) amongst 30 ARJ-LNPCPs treated by EMR with margin thermal ablation (EMR-T) vs. those that did not. Comparing a universal EMR algorithm (UEA) and a selective resection algorithm (SRA), significant differences in cancer after EMR (SRA 1 (1.0%) vs. UEA 35 (12.1%); p = 0.001), and curative oncologic resection (SRA 7 (33.3%) vs. UEA 2 (5.7%); p = 0.010) were identified. Significant differences in resection duration (35 minutes vs. 25 minutes; p<0.001) technical success (93.0% vs. 96.6%; p=0.026) and use of adjuvant modalities (46.2% vs. 7.6%; p<0.001), were identified between previously attempted LNPCPs (PA-LNPCPs) and naïve LNPCPs. Recurrence was not identified in 65 PA-LNPCPs which underwent EMR-T at SC1 vs. 9 (18.0%; p<0.001) which did not. Significant deep mural injury (S-DMI) occurred in 101 cases (2.7%) which underwent EMR. Successful defect closure was achieved in 98 (97.0%). No difference in technical success (94 (93.1%) vs. 3316 (91.7%) p = 0.62) or SC1 recurrence (12 (20.0%) vs. 363 (13.6%); p = 0.15) were identified between LNPCPs with and without S-DMI. Significant differences in sensitivity (90.9% vs. 52.7%), specificity (96.3% vs. 93.7%) and SMIC miss rate (0.6% vs. 5.9%) between flat and nodular LNPCPs were identified (all p < 0.027). Multiple logistic regression identified nodular morphology (OR 7.2; 95%CI 2.8-18.9) as a predictor of missed cancer.
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Date
2023Rights statement
The author retains copyright of this thesis. It may only be used for the purposes of research and study. It must not be used for any other purposes and may not be transmitted or shared with others without prior permission.Faculty/School
Faculty of Medicine and Health, Westmead Clinical SchoolAwarding institution
The University of SydneyShare