Agarwal Amol, Garimall Sidyarth, Colling Caitlin, Ahmad Nuzhat A, Kochman Michael L, Ginsberg Gregory G, Chandrasekhara Vinay
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
Int J Colorectal Dis. 2018 Oct;33(10):1333-1340. doi: 10.1007/s00384-018-3075-x. Epub 2018 May 10.
To investigate advanced neoplasia (AN) after endoscopic mucosal resection (EMR) of colonic laterally spreading lesions (LSLs).
A retrospective study of patients who underwent injection-assisted EMR of colonic LSLs ≥ 10 mm was performed. Primary outcome was overall rate of AN at initial surveillance colonoscopy. Secondary outcomes were the rates of residual AN (rAN) at the EMR site and metachronous AN (mAN), and analysis of risk factors for AN, including effect of surveillance guidance.
Three hundred seventy-four patients underwent successful EMR for 388 LSLs. AN occurred in 66/374 (17.6%) patients on initial surveillance colonoscopy at median follow-up of 364.5 days. Two patients had both rAN and mAN, for a total of 68 instances of AN, including 30/374 (8.0%) cases of rAN and 38/374 (10.2%) cases of mAN. On multivariate analysis, use of piecemeal resection was associated with increased likelihood of residual AN (P = 0.003, OR 9.2, 95% CI 2.1-33.3). Twenty-nine out of thirty cases (96.7%) of rAN were successfully endoscopically managed at surveillance colonoscopy.
AN occurred in 17.6% of all patients at initial surveillance colonoscopy at a median of 1 year after EMR. Roughly half of the instances of AN were metachronous lesions. Our data support a 1-year surveillance interval after EMR of LSLs ≥ 10 mm with careful inspection of the entire colon, not just the prior resection site.
研究结肠侧向发育型病变（LSL）内镜黏膜切除术（EMR）后高级别瘤变（AN）情况。
对接受注射辅助EMR治疗的直径≥10 mm结肠LSL患者进行回顾性研究。主要结局为初次监测结肠镜检查时AN的总体发生率。次要结局为EMR部位残留AN（rAN）和异时性AN（mAN）的发生率，以及AN的危险因素分析，包括监测指导的效果。
374例患者成功接受了388处LSL的EMR。在中位随访364.5天时，初次监测结肠镜检查时66/374（17.6%）例患者发生AN。2例患者同时存在rAN和mAN，共68例AN，包括30/374（8.0%）例rAN和38/374（10.2%）例mAN。多因素分析显示，采用分片切除与残留AN可能性增加相关（P = 0.003，OR 9.2，95%CI 2.1 - 33.3）。30例rAN中有29例（96.7%）在监测结肠镜检查时通过内镜成功处理。
EMR后中位1年时，初次监测结肠镜检查时17.6%的患者发生AN。约一半的AN病例为异时性病变。我们的数据支持对直径≥10 mm的LSL进行EMR后1年的监测间隔，需仔细检查整个结肠，而不仅仅是先前的切除部位。
