Expanding Cold EMR to Large Laterally Spreading Lesions
Douglas K. Rex, MD, FASGE, reviewing Mangira D, et al. Gastrointest Endosc 2020 Jan 15.
In 5 Australian academic hospitals, cold EMR was performed on 204 polyps ≥20 mm in 186 patients. Exclusions were any suspicion of submucosal invasion, any lesion with a 1s component >10 mm, pedunculated polyps, active or quiescent colitis, and rectal lesions. Sixty-six percent of the lesions were sessile serrated lesions.
There was follow-up at 6 months in 80.4% of polyps, in which the recurrence rate (about half had biopsies of the scar) was 5.5%. Recurrences were treated primarily with cold techniques. A multivariable analysis did not show any variables independently associated with recurrence except cecal location. In 155 lesions with a normal first follow-up, 3.5% showed a recurrence in a second examination. Serrated histology was not associated with recurrence.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
Douglas K. Rex, MD, FASGE
Mangira D, Cameron K, Simons K, et al. Cold snare piecemeal endoscopic mucosal resection of large sessile colonic polyps ≥20 mm (with video). Gastrointest Endosc 2020 Jan 15. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2019.12.051)