Impact of margin thermal ablation after endoscopic mucosal resection of large (≥20 mm) non-pedunculated colonic polyps on long-term recurrence.

IF 23 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Gut Pub Date : 2024-12-10 DOI:10.1136/gutjnl-2024-332907
Timothy O'Sullivan, Francesco Vito Mandarino, Julia L Gauci, Anthony M Whitfield, Clarence Kerrison, James Elhindi, Catarina Neto do Nascimento, Sunil Gupta, Oliver Cronin, Anthony Sakiris, Juan Francisco Prieto Aparicio, Sophie Arndtz, Gregor Brown, Spiro Raftopoulos, David Tate, Eric Y Lee, Stephen J Williams, Nicholas Burgess, Michael J Bourke
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Abstract

Background and aims: The efficacy of colorectal endoscopic mucosal resection (EMR) is limited by recurrence and the necessity for conservative surveillance. Margin thermal ablation (MTA) after EMR has reduced the incidence of recurrence at the first surveillance colonoscopy at 6 months (SC1). Whether this effect is durable to second surveillance colonoscopy (SC2) is unknown. We evaluated long-term surveillance outcomes in a cohort of LNPCPs that have undergone MTA.

Methods: LNPCPs undergoing EMR and MTA from four academic endoscopy centres were prospectively recruited. EMR scars were evaluated at SC1 and in the absence of recurrence, SC2 colonoscopy was conducted in a further 12 months. A historical control arm was generated from LNPCPs that underwent EMR without MTA. The primary outcome was recurrence at SC2 in all LNPCPs with a recurrence-free scar at SC1.

Results: 1152 LNPCPs underwent EMR with complete MTA over 90 months until October 2022. 854 LNPCPs underwent SC1 with 29/854 (3.4%) LNPCPs demonstrating recurrence. 472 LNPCPs free of recurrence at SC1 underwent SC2. 260 LNPCPs with complete SC2 follow-up formed the control arm from January 2012 to May 2016. Recurrence at SC2 was significantly less in the MTA arm versus controls (1/472 (0.2%) vs 9/260 (3.5%); p<0.001)).

Conclusion: LNPCPs that have undergone successful EMR with MTA and are free of recurrence at SC1 are unlikely to develop recurrence in subsequent surveillance out to 2 years. Provided the colon is cleared of synchronous neoplasia, the next surveillance can be potentially extended to 3-5 years. Such an approach would reduce costs and enhance patient compliance.

内镜粘膜切除大(≥20 毫米)非梗阻性结肠息肉后的边缘热消融对长期复发的影响。
背景和目的:结直肠内镜粘膜切除术(EMR)的疗效受到复发和保守监测必要性的限制。内镜黏膜切除术后的边缘热消融术(MTA)可降低 6 个月后首次结肠镜监测(SC1)时的复发率。这种效果是否能持续到第二次结肠镜检查(SC2)尚不清楚。我们对一组接受过 MTA 的 LNPCP 的长期监控结果进行了评估:我们前瞻性地招募了四个学术内镜中心接受 EMR 和 MTA 检查的 LNPCP。在SC1时对EMR疤痕进行评估,如果没有复发,则在12个月后进行SC2结肠镜检查。历史对照组由未接受 MTA 的 LNPCPs 组成。主要结果是所有在 SC1 时无复发疤痕的 LNPCP 在 SC2 时的复发情况:截至 2022 年 10 月,1152 名 LNPCP 在 90 个月内接受了带有完整 MTA 的 EMR。854 个 LNPCP 接受了 SC1,29/854(3.4%)个 LNPCP 显示复发。472 个在 SC1 时没有复发的 LNPCP 接受了 SC2。2012 年 1 月至 2016 年 5 月期间,260 例完成 SC2 随访的 LNPCP 组成对照组。MTA组的SC2复发率明显低于对照组(1/472(0.2%)vs 9/260(3.5%);p结论:使用 MTA 成功进行 EMR 并在 SC1 时没有复发的 LNPCP,在随后 2 年的监测中不太可能复发。如果结肠中没有同步瘤,下次监测有可能延长到 3-5 年。这种方法可以降低成本,提高患者的依从性。
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来源期刊
Gut
Gut 医学-胃肠肝病学
CiteScore
45.70
自引率
2.40%
发文量
284
审稿时长
1.5 months
期刊介绍: Gut is a renowned international journal specializing in gastroenterology and hepatology, known for its high-quality clinical research covering the alimentary tract, liver, biliary tree, and pancreas. It offers authoritative and current coverage across all aspects of gastroenterology and hepatology, featuring articles on emerging disease mechanisms and innovative diagnostic and therapeutic approaches authored by leading experts. As the flagship journal of BMJ's gastroenterology portfolio, Gut is accompanied by two companion journals: Frontline Gastroenterology, focusing on education and practice-oriented papers, and BMJ Open Gastroenterology for open access original research.
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