Su1072 ENDOSCOPIC MANAGEMENT OF RESIDUAL OR RECURRENT NEOPLASIA FOLLOWING PIECEMEAL ENDOSCOPIC MUCOSAL RESECTION IS EFFICACIOUS.

Abstract

Endoscopic mucosal resection (EMR) is the primary treatment method for complex colon polyps. Current guidelines recommend surveillance colonoscopy at 6 months following piecemeal EMR due to residual or recurrent neoplasia (RN) rate of up to 15%. There is limited data on management outcomes when RN occurs. The primary aim of this study was to evaluate the efficacy of endoscopic management of RN following EMR. We conducted a retrospective cohort study of patients who had RN on surveillance colonoscopy following EMR of a large colon polyp by 3 gastroenterologists with EMR expertise at a single center between 2010 and June 2019. The primary outcome was successful resolution of the RN, defined as at least one surveillance colonoscopy without neoplasia seen at the EMR site. Among 483 polyps resected in 407 patients, RN was identified on first surveillance colonoscopy (SC1) in 59 cases (12.2%). Four cases of RN were not felt amenable to endoscopic resection and referred to surgery. Endoscopic resection was performed in the remaining 55 cases (Table). The majority (91%) of RN had visibly abnormal tissue at the prior EMR site; only 9% had RN diagnosed on biopsy of an apparently normal scar. Resection was performed utilizing a variety of techniques: underwater EMR (12.7%), hot EMR (36.4%), cold EMR (5.5%), snare resection (16.4%), and cold forceps (29.1%), respectively. Adjunctive therapies were used in 45.5% of resections, with APC in 30.9%, cold forceps in 20.0%, hot avulsion in 7.3%, and soft coagulation in 3.6% of cases. Additional follow up surveillance colonoscopy data until RN was resolved was available for 44 cases. One patient had intramucosal adenocarcinoma within RN pathology on their second surveillance colonoscopy (SC2) and was referred for surgical management. The majority (70.5%) had no RN at SC2, while 27.3% required additional endoscopic treatment of RN with subsequent resolution on further surveillance colonoscopy (Figure). In total, 89.6% of patients with RN were confirmed to have been successfully treated. Among the 472 polyps resected with EMR with sufficient follow up, endoscopic treatment of the polyp was successful in 98.9% of cases. Although recurrent or residual neoplasia is common after piecemeal polypectomy, it is adequately treated in nearly all patients. Use of multiple resection modalities may be necessary for successful treatment based on our observations. Thus, concerns for RN should not significantly impact decision to perform EMR for colorectal polyps.View Large Image Figure ViewerDownload Hi-res image Download (PPT)