Su1514 Outcomes of Colorectal Endoscopic Resection: Short-Term Results of a Prospective Multicenter Italian Cooperative Study

Abstract

Outcomes of Colorectal Endoscopic Resection: Short-Term Results of a Prospective Multicenter Italian Cooperative Study Livio Cipolletta, Maria Antonia Bianco, Federico Buffoli, Giuseppe Gizzi, Gianluca Rotondano, Francesco Tessari Gastroenterology, Hospital Maresca, Naples, Italy; EDP Idea 99, Padova, Italy; Gastroenterologia, Istituti Ospitalieri, Cremona, Italy; Endosocpia Digestiva, Casa di Cura Toniolo, Bologna, Italy Background & Aims: To assess efficacy and safety of endoscopic resection (ER) techniques to remove colorectal superficial neoplastic lesions Methods: Patients with colonoscopic evidence of either sessile polyps or non-polypoid lesions 10 mm (LST) or smaller if with depressed surface (Paris type 0-IIc) submitted to ER were recruited in a prospective study involving 46 sites throughout Italy. Runin period was 3 mo (May-July 2010). Data on clinical and endoscopic features, technical details of resection, final histology and procedure-related complications were analysed. The study is ongoing to assess long-term outcomes (12 mo recurrence). Results: Preliminary analysis included a total of 933 lesions resected in 865 patients (505 M [58.2%], mean age [SD] 66.0 [ 10.6] years). Most colorectal lesions removed were sessile polyps (63.6%), followed by LST (27.1%) and depressed NPL (9.3%). 18.4% of polyps and 21.6% of LST were sized 30 mm. Lesions were prevalent in the proximal colon (50% of polyps, 71% of LST and 60.5% of depressed LNP). The “inject and cut” technique was the most often used (95.7%). ESD was reported in 13 cases (1.4%). Lifting of the lesions was systematically attempted with standard injection needle (96.5%) or hydro-jet systems (3.5%). A non-lifting sign was reported in 2.3% of records. En-bloc resection was possible in 70.1%, whereas 29.9% of lesions required a piecemeal resection. APC treatment of resection margins was reported in 18.2% of cases. Overall, complete (R0) resection was achieved in 83% of cases (85.2 en bloc vs. 78% piecemeal, OR for R1 resection 1.54 [1.07-2.2, p 0.017]. Final histology was hyperplastic (6.1%), low-grade adenoma (59.2%), high-grade adenoma (31.1%) and submucosal cancer (3.6%). Elective surgery for advanced histology was reported in 23 cases. Complications occurred in 84 instances (9%): 3 perforations, 7 transmural burn and 74 bleeding (54 immediate, 12 late and 5 both);hemorrhage occurred in 7.9% of all resections, but accounted for 88% of all adverse events and was successfully managed endoscopically in all but 2 cases (surgery). 2 perforations were treated with clip closure and 1 required surgical repair. No complication-related death occurred. Complications occurred more often for lesions 20 mm(15.3% vs. 3.6% 20 mm, OR 4.89 [2.7-8.7], p 0.000) and in piecemeal resections (15.6% vs. 5.5% en bloc, OR 3.17, [1.9-5.1], p 0.000). Conclusions: ER of colorectal lesions is carried out with satisfactory safety and short-term outcomes in Italy. Future efforts should be directed at increasing the diffusion of these techniques as the primary therapeutic option for superficial colorectal neoplastic lesions