Endoscopic Mucosal Resection For Treatment Research Articles

Post-EMR for colorectal polyps, thermal ablation of defects reduces adenoma recurrence: A meta-analysis.

Background and study aims Adenoma recurrence is one of the key limitations of endoscopic mucosal resection (EMR), which occurs in 15 % to 30 % of cases during first surveillance colonoscopy. The main hypothesis behind adenoma recurrence is leftover micro-adenomas at the margins of post-EMR defects. In this systematic review and meta-analysis, we evaluated the efficacy of snare tip soft coagulation (STSC) at the margins of mucosal defects to reduce adenoma recurrence and bleeding complications. Methods Electronic databases such as PubMed and the Cochrane library were used for systematic literature search. Studies with polyps only resected by piecemeal EMR and active treatment: with STSC, comparator: non-STSC were included. A random effects model was used to calculate the summary of risk ratio and 95 % confidence intervals. The main outcome of the study was to compare the effect of STSC versus non-STSC with respect to adenoma recurrence at first surveillance colonoscopy after thermal ablation of post-EMR defects. Results Five studies were included in the systematic review and meta-analysis. The total number patients who completed first surveillance colonoscopy (SC1) in the STSC group was 534 and in the non-STSC group was 514. The pooled adenoma recurrence rate was 6 % (37 of 534 cases) in the STSC arm and 22 % (115 of 514 cases) in the non-STSC arm, (odds ratio [OR] 0.26, 95 % confidence interval [CI], 0.16–0.41, P = 0.001). The pooled delayed post-EMR bleeding rate 19 % (67 of 343) in the STSC arm and 22 % (78 of 341) in the non-STSC arm (OR 0.82, 95 %CI, 0.57–1.18). Conclusions Thermal ablation of post-EMR defects significantly reduces adenoma recurrence at first surveillance colonoscopy.

Author commentary on Veronique R. H. Van der Voort et al.

Veronique R. H. Van der Voort et al. Efficacy and safety of cap-assisted endoscopic mucosal resection for treatment of nonlifting colorectal polyps

Prognosis of rectal neuroendocrine tumors after endoscopic resection: a single-center retrospective study.

The efficacy of endoscopic resection in patients with rectal neuroendocrine tumors (NETs) which are less than 20 mm in diameter remains unclear. This study aimed to investigate the efficacy and outcomes of different types of endoscopic resection in patients with NETs. We performed a retrospective analysis and follow-up on 98 patients who underwent endoscopic resection for rectal NETs between August 2010 and October 2019 at Guangdong Provincial People's Hospital, China. The lesions were preoperatively classified according to their endoscopic morphology and measured by endoscopic ultrasound. Patients were divided into modified endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) groups depending on the endoscopic treatment they received. The en bloc resection rate, histopathological complete resection rate, and the complication rate of the 2 groups were evaluated after the operation. The risk factors for incomplete resection were also analyzed. The average diameter of the 98 NETs was 6.29±2.90 mm (range, 2-15 mm). The en bloc resection rate of the modified EMR and ESD treatment groups was 97.2% (35/36) and 100% (62/62), respectively. The histopathological complete resection rate was 86.1% (31/36) and 87.1% (54/62), respectively. No tumor recurrence or tumor-related death occurred. There were no statistically significant differences in the rate of histopathological complete resection, perforation, or delayed hemorrhage between the 2 groups (P>0.05). Multivariate analysis demonstrated that the depth of tumor invasion (P=0.007) and tumor diameter (P<0.001) were independent risk factors for histopathological complete resection. Modified EMR and ESD are safe and effective endoscopic approaches for the resection of rectal NETs ≤15 mm in diameter. Endoscopic resection requires a comprehensive preoperative evaluation of risk factors including the depth of tumor invasion and tumor diameter.

Efficacy and safety of cap-assisted endoscopic mucosal resection for treatment of nonlifting colorectal polyps.

BACKGROUND : Suboptimal lifting increases complexity of endoscopic mucosal resection (EMR) for benign colorectal polyps. Cap-assisted EMR (EMR-C) may allow fibrotic polyp tissue to be captured in the snare. This study evaluated the efficacy and safety of EMR-C for benign nonlifting colorectal polyps. METHODS : This was a multicenter study, which prospectively registered all EMR-C procedures (2016-2018) for presumed benign nonlifting colorectal polyps. RESULTS : 70 nonlifting polyps with a median size of 25 mm (interquartile range [IQR] 15-40) were treated with EMR-C. Complete polyp removal was achieved in 68 (97.1 %), including 47 (67.1 %) with EMR-C alone. Overall, 66 polyps showed benign histology, and endoscopic follow-up after a median of 6 months (IQR 6-10) showed recurrence in 19.7 %. First (n = 10) and second (n = 2) benign recurrences were all treated endoscopically. Deep mural injury type III-V occurred in 7.4 % and was treated successfully with clips. CONCLUSION : EMR-C may be an alternative therapeutic option for removal of benign nonlifting polyp tissue. Although recurrence still occurs, repeat endoscopic therapy usually leads to complete polyp clearance.

Efficacy of cold endoscopic mucosal resection vs conventional endoscopic mucosal resection in treatment of nonpedunculated colorectal polyps sized 5-10 mm

Efficacy of cold endoscopic mucosal resection <i>vs</i> conventional endoscopic mucosal resection in treatment of nonpedunculated colorectal polyps sized 5-10 mm

Risk Factors and Prediction Model for Non-curative Resection of Early Gastric Cancer With Endoscopic Resection and the Evaluation.

Background and Study Aim: EGC, also known as Early Gastric Cancer is known to lack the lymph node metastasis and confined along the mucosa, which is treated through an endoscopic resection procedure that includes ESD (Endoscopic Submucosal dissection) and EMR (Endoscopic Mucosal Resection). However, some cases underwent residual disease, recurrence, or additional gastrectomy because of non-curative resection. The following research aims to delineate the threat factors causing the non-curative resection as well as develop a predictive model.Patient and Methods: Effort was taken to collect all the records about the health history of pathologically diagnosed EGC who experienced endoscopic treatment in the Department of Endoscopy, the Capital Medical University, and Beijing Friendship Hospital from January 2012 to January 2020. Patients were grouped into two categories primarily; a curative resection group and finally a non-curative resection group based on the outcomes of the postoperative pathological and immunohistochemical examination results. The statistical methods used included single factor analysis, a multivariate logistic regression analysis and a chi-square test. A nomogram for the prediction of non-curative resection was constructed, which included information on age, gender, resection method, postoperative pathology, tumor size, ulcer, treatment, and infiltration depth. Receiver operating characteristic (ROC) curve analysis and calibration were performed to present the predictive accuracy of the nomogram.Results: Of 443 patients with 478 lesions who had undergone ESD or EMR for EGCs, 127 were identified as being treated non-curative resection. Older patients (>60 years), a large tumor size (>30 mm), submucosal lesion, piecemeal resection, EMR for treatment and undifferentiated tumor histology were associated with non-curative resection group. Our risk nomogram showed good discriminated performance in internal validation (bootstrap-corrected area under the receiver-operating characteristic curve, 0.881; P < 0.001).Conclusions: A validated prediction model was developed to identify people who were subject to undergoing a non-curative resection for ESD. The predictive model that we formulated is essential in providing reliable information to guide the decision-making process on the treatment for EGC before undertaking an endoscopic resection.

Application value of pre-cutting endoscopic mucosal resection in treatment of colorectal laterally spreading tumors

Application value of pre-cutting endoscopic mucosal resection in treatment of colorectal laterally spreading tumors

Underwater vs conventional endoscopic mucosal resection in treatment of colorectal polyps: A meta-analysis.

BACKGROUNDUnderwater endoscopic mucosal resection (UEMR) of colorectal lesions is emerging as an alternative method to conventional endoscopic mucosal resection (EMR); however, it is still controversial whether there is a difference in the effectiveness between UEMR and EMR.AIMTo evaluate the effectiveness and safety of UEMR in the treatment of colorectal polyps.METHODSClinical studies comparing the effectiveness or safety of UEMR in the treatment of colorectal polyps were searched in medical databases, including PubMed, Embase, Cochrane Library, CNKI, and Wanfang Data, monographs, theses, and papers presented at conferences. Statistical analyses were performed using Revman 5.3 software.RESULTSSeven non-randomized controlled trials and one randomized controlled trial met the inclusion criteria. In total, 1382 patients (1511 polyps) were included in the study, including 722 who received UEMR and 789 who received EMR. In the UEMR and EMR groups, the en bloc resection rates were 85.87% and 73.89%, respectively, with a relative risk (RR) value of 1.14 (95% confidence interval [CI]: 1.01-1.30; P < 0.05). In the sub-group analysis, the en bloc resection rate showed no statistically significant difference between the EMR and UEMR groups for polyps less than 20 mm in diameter. However, a statistically significant difference was found between the EMR and UEMR groups for polyps equal to or greater than 20 mm in diameter. The post-endoscopic resection recurrence rates at 3-6 mo of the UEMR and EMR groups were 3.26% and 15.17%, respectively, with an RR value of 0.27 (95%CI: 0.09-0.83; P < 0.05). The post-endoscopic resection recurrence rates of UEMR and EMR at 12 mo were 6.25% and 14.40%, respectively, with an RR value of 0.43 (95%CI: 0.20-0.92; P < 0.05). Additionally, the incidence of adverse events was 8.17% and 6.21%, respectively, with an RR value of 1.07 (95%CI: 0.50-2.30; P > 0.05).CONCLUSIONUEMR is an effective technique for colorectal polyps and appears to have some advantages over EMR, particularly with regard to some treatment outcomes.

Efficacy and safety of modified endoscopic mucosal resection forrectal neuroendocrine tumors: a meta-analysis.

Rectal neuroendocrine tumors are rare with good prognosis. Several endoscopic methods such as endoscopic polypectomy, endoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR), and modified endoscopic mucosal resection (m-EMR) are used in the treatment of rectal neuroendocrine tumors. Although m-EMR is derived from traditional EMR, it has not been widely used in clinical practice. In this study, we compared the efficacy and safety of EMR and m-EMR in the treatment of rectal neuroendocrine tumors by performing a meta-analysis. We searched PubMed, Web of Science, and EMBASE index up to the end of January 2017 for all published literature about EMR and m-EMR in the treatment of rectal neuroendocrine tumors. A total of 11 studies involving 811 patients were included. The pooled data suggested that there was a significantly higher rate of histologic complete resection and endoscopic complete resection among patients treated with m-EMR than those treated with EMR (histologic complete resection: OR = 0.23, 95 % CI = 0.10-0.51, p < 0.01; endoscopic complete resection: OR = 0.13, 95 % CI = 0.02-0.74, p = 0.02). The procedure time of EMR was longer than m-EMR (MD = 2.40, 95 % CI = 0.33-4.46, p = 0.02). There was a significantly higher rate of vertical margin involvement among patients treated with EMR than those treated with m-EMR; whereas, there was no significant difference of lateral margin involvement between the m-EMR and EMR groups (vertical margin involvement: OR = 5.00, 95 % CI = 2.67-9.33, p < 0.01; lateral margin involvement: OR = 1.44, 95 % CI = 0.48-4.37, p = 0.52). There was no significant difference in mean tumor size among patients treated with m-EMR versus those treated with EMR (MD = -0.30, 95 % CI = -0.75-0.14, p = 0.18); further, there was no significant difference in endoscopic mean sizes of the tumor and pathological mean sizes of the tumor between the m-EMR and EMR groups (endoscopic mean sizes of the tumor: MD = 0.20, 95 % CI = -0.44-0.84, p = 0.43; pathological mean sizes of the tumor: MD = 0.62, 95 % CI = -0.68-1.92, p = 0.05). No significant differences were detected among the treatment groups with regard to complications (bleeding: OR = 0.87, 95 % CI = 0.39-1.95, p = 0.73; complications (bleeding and perforation): OR = 0.87, 95 % CI = 0.40-1.88, p = 0.73). The efficacy of m-EMR are better than EMR among patients undergoing endoscopic treatment of rectal neuroendocrine tumors, and the safety of m-EMR is equivalent to EMR treatment.

355 Endoscopic Submucosal Dissection vs. Endoscopic Mucosal Resection for Treatment of Barrett’s Related Superficial Esophageal Neoplasia

INTRODUCTION: The difference in long-term outcomes of endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) for Barrett’s related superficial neoplasia remains unclear. We aimed to compare the rates of local and metachronous recurrence of ESD and EMR in patients with clinically staged BE-associated high-grade dysplasia (HGD) and T1a esophageal adenocarcinoma (EAC). METHODS: Multicenter study at six academic hospitals in the U.S. including patients who underwent ESD for BE-HGD or T1a EAC. Primary outcome was a composite of metastasis and local recurrence rate. A time-to-event analysis was performed to evaluate recurrence. A Kaplan-Meier plot was constructed, and a log-rank test was used to compare the groups. A Cox hazard ratio regression analysis was performed to identify predictors of recurrence. RESULTS: A total of 241 patients were included. 154 underwent EMR, while 84 underwent ESD (Table 1). ESD had higher en bloc (96% vs 33%, P &lt; 0.0001), R0 (76% vs 54%, P = 0.0009) and curative resection rates (75% vs 32%, P &lt; .0001) when compared to EMR. The 24-month local recurrence rate for EMR and ESD was 43% and 11%, respectively (P = 0.0007) (Figure 1). Significantly more endoscopic resection procedures were required to treat recurrence after EMR compared to after ESD (Table 1). EMR, piecemeal resection, positive margins, and non-curative resection were identified as predictors of recurrence on univariate analysis. En bloc resection remained significant after multivariate analysis (Table 2). CONCLUSION: This multicenter study showed that ESD results in more definitive treatment of BE-associated early neoplasia than EMR, with significant lower recurrence rates and less need for repeat endoscopic therapeutic procedures than EMR.

456 Impact of Endoscopic Surveillance on Detection of Dysplasia Progression in Patients With Barrett's Esophagus Who Have Undergone Complete Eradication of Intestinal Metaplasia

INTRODUCTION: Barrett's esophagus (BE) affects up to 15% of patients with gastroesophageal reflux disease and poses high risk of progression to esophageal adenocarcinoma (EAC). While radiofrequency ablation (RFA) and endoscopic mucosal resection (EMR) are effective treatments for dysplastic BE, risk of recurrence remains even after complete eradication of intestinal metaplasia (CEIM). Currently, endoscopic surveillance intervals after RFA ± EMR are informed only by expert opinion and weak evidence. It is unclear if current guidelines are cost-effective or suitable for all patients. The purpose of this study is to assess for variation in surveillance intervals and rates of recurrence in BE patients with high grade dysplasia (HGD). METHODS: A retrospective review of medical records was performed for 70 BE patients who underwent RFA ± EMR for biopsy-proven HGD between January 1, 2010 until November 30, 2018 and received at least 1 surveillance endoscopy with biopsies at 1 year after completion of treatment. These patients were analyzed for adherence to the ACG guidelines of an endoscopy every 3 months for the first year after treatment and for recurrence of dysplasia or development of EAC. RESULTS: At 1 year post treatment completion, CEIM was achieved in 48.6% of patients and non-dysplastic BE was achieved in 32.9% of patients. The average time between the first 4 surveillance intervals was 5.5 months. 14 of 70 patients were adherent to ACG guidelines, and 56 received endoscopies less frequently than recommended. Of the 14 patients who were adherent, 6 developed recurrent dysplasia (1 low grade dysplasia (LGD), 4 HGD) and 1 developed T1b carcinoma at one year. Of the 56 patients who received surveillance endoscopies less frequently than recommended, 7 developed recurrent dysplasia (4 LGD, 3 HGD) at one year. CONCLUSION:: Adhering to ACG surveillance guidelines following RFA±EMR treatment for HGD is difficult and requires close attention to the scheduling of these BE patients. Although our sample size is small, our study showed that the recurrence of dysplasia was not significantly reduced in individuals that were adherent to the ACG guidelines when compared to those that received surveillance less frequently than recommended. Further studies are needed to inform the development of evidence-based guidelines that identify recurrence or progression of dysplastic BE early, while minimizing the costs of over-surveillance.

Analysis on risk factors of positive vertical resection margin after endoscopic treatment of rectal neuroendocrine tumors

Objective: To analyze the risk factors of positive vertical resection margin of the postoperative specimens after endoscopic treatment of rectal neuroendocrine tumors (NET). Methods: A case-control study was performed. Clinical data of patients with rectal NET (G1) undergoing endoscopic treatment between January 2015 and June 2018 at the Department of Gastroenterology, Beijing Tsinghua Changgung Hospital were retrospectively collected. Inclusion criteria: cases underwent endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), whose mucosal specimens were pathologically confirmed as NET, and NET was confined to the rectum by nuclide imaging examination before endoscopic treatment. Those with incomplete clinical data or follow-up data were excluded. Resected specimen was fixed and sliced every 2 mm, and when tumor cells were found to infiltrate the vertical cutting edge, the positive vertical margin was defined. Associations of gender, age, resection method, tumor diameter, lesion morphology (nodular lesions, biopsy or post-treatment scar-like changes), mitotic figure, Ki-67 index, etc. and positive vertical margin were analyzed. Univariate analysis was performed using binary logistic analysis and multivariate analysis was performed using logistic regression model. Results: A total of 133 patients with rectal NET were enrolled, including 93 males and 40 females, with an average age of (50.0±10.7) years. Sixty-four patients received EMR treatment and 3 patients (4.7%) had positive vertical margins. While 69 patients received ESD treatment and 13 (18.8%) had positive vertical margins. After endoscopic treatment, 16 cases (12.0%) were vertical positive margin, including 11 males and 5 females with an average age of (52.4±10.4) years. The lesion diameter was (9.0±4.7) mm. Univariate analysis showed that lesion diameter ≥10 mm (χ(2)=5.575, P=0.018) and scar-like changes (χ(2)=3.894, P=0.048) were significantly associated with positive vertical margin. Multivariate analysis showed that the lesion diameter ≥10 mm (OR=10.136, 95%CI: 2.114 to 48.591, P=0.004) was an independent risk factor for positive vertical margin of the specimen after endoscopic treatment of rectal NET. Conclusion: The diameter of rectal NET ≥10 mm indicates a high risk for positive vertical margin after endoscopic treatment.

Clinical study of endoscopic mucosal resection for digestive tract early cancer and precancerous lesions treatment

&lt;p class="p1"&gt;The clinical effect of endoscopic mucosal resection (EMR) on the digestive tract of early cancer and precan-cerous lesions was analyzed. 63 patients with early gastrointestinal cancer and precancerous lesions treated in our hospital from January 2013 to May 2015 were recruited for this study. Patients were randomly divided into the observation group (32 cases) and the control group (31 cases). The control group underwent conventional surgical treatment, while the observation group underwent EMR. Both groups were observed for the clinical effect. The curative resection rate was 100.0% (P &amp;gt; 0.05). The postoperative complication rate was 3.1% (1/32) in the observation group and 25.8% (8/31) in the control group. The operation time for the observation group was significantly shorter than the control group (P &amp;lt; 0.05). Subjects were followed up for 1 year. Both groups showed no primary tumor metastasis and recurrence (P &amp;gt; 0.05). EMR treatment showed good effect and significantly fewer complications in patients. &lt;/p&gt;

Clinical study of endoscopic mucosal resection for digestive tract early cancer and precancerous lesions treatment

&lt;p class="p1"&gt;The clinical effect of endoscopic mucosal resection (EMR) on the digestive tract of early cancer and precan-cerous lesions was analyzed. 63 patients with early gastrointestinal cancer and precancerous lesions treated in our hospital from January 2013 to May 2015 were recruited for this study. Patients were randomly divided into the observation group (32 cases) and the control group (31 cases). The control group underwent conventional surgical treatment, while the observation group underwent EMR. Both groups were observed for the clinical effect. The curative resection rate was 100.0% (P &amp;gt; 0.05). The postoperative complication rate was 3.1% (1/32) in the observation group and 25.8% (8/31) in the control group. The operation time for the observation group was significantly shorter than the control group (P &amp;lt; 0.05). Subjects were followed up for 1 year. Both groups showed no primary tumor metastasis and recurrence (P &amp;gt; 0.05). EMR treatment showed good effect and significantly fewer complications in patients. &lt;/p&gt;

Efficacy of Precut Endoscopic Mucosal Resection for Treatment of Rectal Neuroendocrine Tumors.

Background/AimsEndoscopic resection is the first-line treatment for rectal neuroendocrine tumors (NETs) measuring <1 cm and those between 1 and 2 cm in size. However, conventional endoscopic resection cannot achieve complete resection in all cases. We aimed to analyze clinical outcomes of precut endoscopic mucosal resection (EMR-P) used for the management of rectal NET. MethodsEMR-P was used to treat rectal NET in 72 patients at a single tertiary center between 2011 and 2015. Both, circumferential precutting and EMR were performed with the same snare device in all patients. Demographics, procedural details, and histopathological features were reviewed for all cases. ResultsMean size of the tumor measured endoscopically was 6.8±2.8 mm. En bloc and complete resection was achieved in 71 (98.6%) and 67 patients (93.1%), respectively. The mean time required for resection was 9.0±5.6 min. Immediate and delayed bleeding developed in six (8.3%) and 4 patients (5.6%), respectively. Immediate bleeding observed during EMR-P was associated with the risk of delayed bleeding. ConclusionsBoth, the en bloc and complete resection rates of EMR-P in the treatment of rectal NETs using the same snare for precutting and EMR were noted to be high. The procedure was short and safe. EMR-P may be a good treatment choice for the management of rectal NETs.

Expression of macrophage inhibitory cytokine-1 in early gastric cancer cases treated using endoscopic mucosal resection and the correlation with prognosis.

The expression of macrophage inhibitory cytokine-1 (MIC-1) of early gastric cancer treated using endoscopic mucosal resection (EMR) and its correlation with prognosis were investigated. One hundred and forty-seven patients with early gastric cancer (less than 20 mm in diameter) were recruited and assigned into an observation group (75 cases) or a control group (72 cases), according to treatment. The control group was treated with a radical resection by the conventional laparotomy approach and the observation group was treated by EMR. Differences in operative outcomes and prognosis were compared between the two groups. Complete lesion resection rates of the two groups were 100%. The amount of bleeding, operation time and postoperative complication rates in the observation group were each significantly lower than those in the control group (P<0.05). The serum MIC-1 levels in the two groups were reduced, with the observation group being significantly lower than that of the control group (P<0.05). The progression-free survival was significantly prolonged and the recurrence rate was significantly lower in the observation group compared to the control group, with the difference being statistically significant (P<0.05). In conclusion, EMR treatment of early gastric cancer was observed to be safe and effective in this study and can reduce the expression level of serum MIC-1 after the operation. EMR can also increase the survival period and reduce the recurrence rate, and MIC-1 can be used as an important index to predict the prognosis of the disease.

Efficacy and Safety of Duodenal Endoscopic Mucosal Resection: A Single-Center Experience

Introduction: Endoscopic mucosal resection (EMR) for duodenal lesions is an appealing alternative to surgical resection. However, the duodenum is considered a challenging and high-risk site for endoscopic interventions. Herein, we report a single-center 2-year experience of performing duodenal EMR to assess its therapeutic outcomes. Aim: Evaluate efficacy and safety of EMR for duodenal adenoma resection and assess risk factors associated with residual duodenal polyp at follow up. Methods: A retrospective review of all the patients undergoing EMR of non-ampullary and non-polyposis associated duodenal adenomas of size > 10 mm at a tertiary referral center between January 2014 and December 2015 was performed. Data collection included information about: patient demographics, lesion characteristic, procedure details and follow up details. (Table 1) Main outcomes included: admission, intraprocedural bleeding (IPB), delayed bleeding (DB) and residual/recurrent adenomas. Groups were compared using t-tests and chi-square. (Table 2)Table 1: Characteristics of the study subjectsTable 2: Association of different factors with procedure outcomesResults: Sixty patients were included with a mean age of 69.7 ± 10.7 years, 58.3% were males. Mean lesion size was 26.8 ± 15.9 ranging from 10 to 70 mm, 58% of them were tubular adenomas. Most of the lesions (71.7%) were resected in a piecemeal fashion. IPB was reported in 16 (26.7%) cases and 9 (15%) patients had prophylactic clips to close the mucosal defect. There were no reported immediate complications, while 6 patients had delayed complications and 4 of them were bleedings. Admission was significantly associated with lesion size, villous component, EMR duration, piecemeal resection and number of resected pieces. IPB was associated with piecemeal resection and number of resected pieces, however, neither EMR duration nor recent use of anti-platelet or anti-coagulant agents were associated with IPB. Delayed bleeding was only associated with EMR duration. Thirty (50%) patients underwent their first surveillance endoscopy, 10 (32.3%) of them had residual adenoma. All of these residual/recurrences were managed endoscopically. Presence of residual tissue was slightly associated, yet not significant, with the villous component and piecemeal resection (p = 0.068 & 0.083 respectively). Conclusion: Overall, EMR treatment for duodenal adenomas is an effective and safe procedure in referral center-settings. However, IPB and recurrence are major concerns. Longer procedure duration was strongly associated with delayed bleeding.

Sa1762 Usefulness of Precut Endoscopic Mucosal Resection for Treatment of Rectal Neuroendocrine Tumors

Sa1762 Usefulness of Precut Endoscopic Mucosal Resection for Treatment of Rectal Neuroendocrine Tumors

Application value of endoscopic submucosal dissection and endoscopic mucosal resection for treatment of rectal carcinoids

The objective of this study is to explore the clinical effect and safety of endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) for treatment of rectal carcinoids. A retrospective analysis was conducted on 42 patients with rectal carcinoids who were hospitalized and subjected to surgical treatment in our hospital from January 2010 to November 2015. The patients were categorized into two groups based on treatment received: ESD (n = 22) and EMR (n = 20). The patients were analyzed and compared to determine differences in lesion size, operation time, histopathologically curative resection rate, intraoperative complications, complete lesion resection rate, and postoperative recurrence rate between the two groups. Operation time (25.2 ± 20.1 min) and wound surface diameter (36.2 ± 10.1 mm) were significantly higher in the ESD group than those in the EMR group (12.6 ± 8.4 min and 18.6 ± 5.9 mm, respectively) (P < 0.05). The differences in complete lesion and histopathologically curative resection rates between the two groups were not statistically significant (P > 0.05). Delayed hemorrhage was the primary postoperative complication in both groups. Postoperative follow-up was performed for 3-71 months, and the median follow-up time was 45 months. Recurrence was noted 32 months after surgery in one patient in the EMR group (4.5%), whereas recurrence was not detected in the ESD group. ESD and EMR are safe and effective methods for treatment of rectal carcinoids. Moreover, ESD had less risk of recurrence, more complete resection rate which could provide more information for postoperative treatment.

Endoscopic mucosal resection of large colorectal adenomas: Only for expert centers?

Endoscopic mucosal resection of large colorectal adenomas: Only for expert centers?