Should a Biopsy of Normal-Appearing EMR Scars Be Performed at Follow-up?

Should a Biopsy of Normal-Appearing EMR Scars Be Performed at Follow-up?

Douglas K. Rex, MD, MASGE, reviewing João M, et al. Endoscopy 2023 Jan 23.

Traditionally, even if careful inspection of an EMR scar at follow-up shows no residual polyp, a biopsy should still be performed to rule out histologic evidence of recurrence that is not endoscopically visible. However, with modern high-definition imaging and electronic chromoendoscopy, performing biopsies of scars without apparent recurrence might not be necessary. Some endoscopy professional societies have issued recommendations to this effect. However, results reporting sensitivity and negative predictive value of advanced, modern imaging have been mixed.

In this multicenter study, 203 EMR scars from lesions 20 mm or larger were examined by white-light (WLE) endoscopy and narrow-band imaging (NBI) in a randomized order. Mean lesion size was 30 mm, and the overall recurrence rate was 29.6%. WLE identified 83% of histologically confirmed recurrences, and NBI 90%. The negative predictive value was 96% for NBI and 93% for WLE.

Douglas K. Rex, MD, FASGE


The investigators concluded that these results support no need for performing biopsies of normal-appearing EMR scars. However, calling these levels of sensitivity adequate seems an arbitrary judgment. Some data have found that performing a biopsy of normal-appearing scar tissue at the first follow-up enables triage of patients into a group considered cured (negative histology) versus one that has a higher risk of eventual overt recurrence (positive biopsy). Overall, the jury seems to still be out on whether performing a biopsy of normal-appearing scars has value.

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.


João M, Areia M, Pinto-Pais T, et al. Can white light endoscopy or narrow band imaging preclude routine biopsy of colorectal endoscopic mucosal resection scars? A multicentre randomized single-blinded crossover trial. Endoscopy 2023 Jan 23. (Epub ahead of print) (

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