Underwater endoscopic mucosal resection for recurrences after previous piecemeal resection of colorectal polyps

초록

Background: Conventional endoscopic treatment of a recurrent adenoma after piecemeal EMR (PEMR) of a colorectal laterally spreading tumor (LST) is technically difficult with low en bloc resection rates because of the inability to snare fibrotic residual. Objective: To assess the feasibility of salvage underwater EMR (UEMR) for the treatment of recurrent adenoma after PEMR of a colorectal LST. Design: Retrospective, cross-sectional study. Setting: Single, tertiary-care referral center. Patients: Patients who have recurrent adenoma after PEMR of colorectal LST (>= 2 cm). Interventions: UEMR versus EMR. Main Outcome Measurement: En bloc resection rate, endoscopic complete removal rate, recurrence rate on follow-up colonoscopy, adjunctive ablation rate with argon plasma coagulation (APC) during salvage procedure, and independent predictive factors for successful en bloc resection and endoscopic complete removal. Results: Eighty salvage procedures (36 UEMRs vs 44 EMRs) were analyzed. En bloc resection rate (47.2% vs 15.9%, P = .002) and endoscopic complete removal rate (88.9% vs 31.8%, P < .001) were higher in the UEMR group than in the EMR group. APC ablation of visible residual during salvage procedure was lower in UEMR group than EMR group (11.1% vs 65.9%, P < .001). Recurrence rate on follow-up colonoscopy was significantly lower in the UEMR group than the EMR group (10% vs 39.4%, P = .02). UEMR was an independent predictor of successful en bloc resection and endoscopic complete removal. Limitations: Retrospective, single-center study. Conclusions: UEMR can be a useful and feasible technique as a salvage procedure for recurrent colorectal adenoma after PEMR.

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