Post-EMR Adenoma Recurrences Are Effectively Treated Endoscopically

Post-EMR Adenoma Recurrences Are Effectively Treated Endoscopically

Douglas K. Rex, MD, MASGE, reviewing Tate DJ, et al. Gut 2023 Oct.

About 15% of large (≥20 mm) nonpedunculated colorectal polyps (LNPCPs) removed by piecemeal endoscopic mucosal resection (EMR) have evidence of recurrence at the first endoscopic follow-up. This rate has been around 5% since the advent of thermal treatment of the defect margin after EMR. Recurrence is often considered a major downside of piecemeal resection and one argument favoring en bloc resection.

In a large experience spanning 139 months, 213 (14.6%) patients had residual adenoma at surveillance. Most recurrences were small polyps, with 48% ranging from 2.5 to 5.0 mm in size and 78.7% unifocal. Of 202 patients with macroscopically visible residual adenoma, 96% underwent successful endoscopic treatment.

Treatment typically involved another attempt at submucosal injection followed by snare resection or just hot snare resection. For flat and fibrotic areas, cold-forceps avulsion with adjuvant snare-tip soft coagulation was used.

Only one endoscopic treatment was necessary to cure recurrence in 85.2% of patients. Nine patients (4.2%) eventually required surgery for failure to eradicate residual adenoma.

Douglas K. Rex, MD, FASGE


These data indicate that experts can effectively cure residual adenoma on scarred-down tissue using traditional snaring and avulsion techniques. More advanced methods, such as endoscopic submucosal dissection and endoscopic full-thickness resection, can be used but are generally more time-consuming and riskier than snaring and avulsion.


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.


Tate DJ, Desomer L, Argenziano ME, et al. Treatment of adenoma recurrence after endoscopic mucosal resection. Gut 2023;72:1875-1886. (


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