Predicting Recurrence After Cold Endoscopic Mucosal Resection
Douglas K. Rex, MD, MASGE, reviewing Suresh S, et al. Endosc Int Open 2021 May 27.
Cold EMR is increasingly popular because of its low risk of complications. However, there do seem to be more recurrences after cold EMR.
In a report from a single center, 310 nonpedunculated lesions ≥20 mm in size were excised by cold EMR, with follow-up. The overall adenoma recurrence rate was 34.8%. Patients with recurrences were more likely to be older, have had endoscopic clips placed at the index procedure (about 5% had undergone clipping because of the need to restart anticoagulation), and be Asian or African American. With regard to specific polyp predictors, size was an important predictor. The mean size in recurrent lesions was 33.5 mm versus 27.2 mm for those without recurrence. Recurrence was 27% for lesions 20 to 30 mm in size, 48% for lesions 31 to 40 mm in size, 64% for those 41 to 50 mm, and 77% for those >50 mm. Recurrence was also associated with tubulovillous histology (53%) versus tubular (30%) and sessile serrated lesions (13%). Recurrence rates were also high at 61% in the group with high-grade dysplasia.
COMMENTThese are the highest recurrence rates yet reported for cold EMR and come from a center of excellence for this procedure. While we await the results of randomized controlled trials, it seems reasonable to use cold EMR in selected patients but to emphasize the importance of follow-up and for operators to have skill in the management of recurrences.
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.
CITATION(S)
Suresh S, Zhang J, Ahmed A, et al. Risk factors associated with adenoma recurrence following cold snare endoscopic mucosal resection of polyps ≥20mm: a retrospective chart review. Endosc Int Open 2021;9:E867-E873. (https://doi.org/10.1055/a-1399-8398)
