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Risk factors for local recurrence of large gastrointestinal lesions after endoscopic mucosal resection

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Abstract

Background

Endoscopic mucosal resection (EMR) is the primary treatment modality for superficial gastrointestinal mucosal lesions > 2 cm. However, the procedure carries some risk of complications including bleeding, perforation, and local recurrence. This study aimed to examine factors associated with EMR outcomes, especially in terms of local recurrence.

Methods

This study retrospectively evaluated patients who underwent EMR and full closure with prophylactic clips for upper and lower gastrointestinal lesions > 2 cm at Cleveland Clinic Florida, between January 2013 and December 2018 with follow-up endoscopic evaluation for recurrence.

Results

A total of 2031 endoscopic polypectomy cases were examined; 307 EMR procedures among 271 patients (52% were female, mean age 65.6 ± 11.1 years) who satisfied the inclusion criteria were included in the study. There were no perforations reported. The rate of post-polypectomy delayed bleeding was 1.6%, and the local recurrence rate in this cohort was 7.1%. Recurrent cases were successfully endoscopically managed. In the multivariate regression analysis, age > 70 years (OR = 3.20, 95% CI 1.17–8.76, p = .023), body mass index (OR = 1.12, 95% CI 1.03–1.23 p = .008), and lesion size ≥ 35 mm (OR = 11.51, 95% CI 3.54–37.40, p =  < .001) were independent predictors for recurrence.

Conclusions

Age > 70 years, increased lesion size, and obesity were found to be independent predictors of local recurrence among EMR procedures for gastrointestinal lesions > 2 cm. However, there is a need for larger-scale studies on this topic.

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Authors and Affiliations

  1. Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Florida, Weston, FL, USA

    Yasar Colak, Badar Hasan, Mamoon Ur Rashid & Tolga Erim

  2. Department of Gastroenterology, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey

    Yasar Colak

  3. Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA

    Walid Hassaballa, Victor Strassmann, Giovanna DaSilva & Steven D. Wexner

Authors
  1. Yasar Colak
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  2. Badar Hasan
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  3. Walid Hassaballa
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  4. Mamoon Ur Rashid
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  5. Victor Strassmann
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  6. Giovanna DaSilva
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  7. Steven D. Wexner
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  8. Tolga Erim
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Contributions

S.D.W., W.H., G.D., and T.E. conceived and designed the project. W.H., Y.C, B.H., M.R., and V.S. collected the data. Y.C., B.H., W.H., M.R., and V.S. analyzed and interpreted the data. W.H. G.D., T.E., and S.D.W. drafted the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Steven D. Wexner.

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Conflict of interest

Dr. Yasar Colak, Badar Hasan, Walid Hassaballa, Mamoon Ur Rashid, Victor Strassmann, Giovanna Dasilva, Steven D. Wexner and Tolga Erim have no conflicts of interest or financial ties to disclose.

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Approved by the Institutional Review Board of our institution.

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Poster presentation at the Annual Meeting of the American Society of Colon and Rectal Surgeons, June 1–5, 2019, Cleveland, OH.

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Colak, Y., Hasan, B., Hassaballa, W. et al. Risk factors for local recurrence of large gastrointestinal lesions after endoscopic mucosal resection. Tech Coloproctol 26, 545–550 (2022). https://doi.org/10.1007/s10151-022-02623-y

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  • DOI: https://doi.org/10.1007/s10151-022-02623-y

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