Postcolorectal Endoscopic Mucosal Resection Follow-up Is Essential

Postcolorectal Endoscopic Mucosal Resection Follow-up Is Essential

Douglas K. Rex, MD, MASGE, reviewing El Rahyel A, et al. Gastroenterology 2020 Oct 29.

There is a well-known risk of adenoma recurrence after piecemeal endoscopic mucosal resection (EMR). 

In a single-center study of 2411 nonpedunculated lesions ≥20 mm in size, with complete EMR and no submucosal invasion by pathologic assessment, the overall recurrence rates at first, second, and third follow-ups were 15.2%, 3.4%, and 1.1%, respectively. Of 155 first overt recurrences treated endoscopically and followed, the rate of residual polyp at the next follow-up was 14.8%. Of 17 lesions that recurred overtly twice and were followed, 94.1% were successfully eradicated by the second treatment. Three patients developed adenocarcinoma at the EMR site during follow-up. Although the study was performed at a referral center, overall, 27.5% of patients did not return for the first follow-up, 40.8% did not return for the second follow-up, and 55.9% did not return for the third follow-up.

Douglas K. Rex, MD, FASGE


While many patients treated at this referral center undoubtedly had follow-up examinations nearer to their homes, the development of late recurrences and even occasional cancers at the EMR site emphasizes the need for systematic follow-up after piecemeal EMR of large, laterally spreading colorectal tumors. It seems likely that widespread application of thermal injury to the defect margin should substantially reduce the problem of adenoma recurrence after EMR, but there are currently insufficient data to suggest that systematic efforts to ensure follow-up are not needed.

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.


El Rahyel A, Abdullah N, Love E, Vemulapal KC, Rex DK. Recurrence after endoscopic mucosal resection: early and late incidence, treatment outcomes, and outcomes in non-overt (histologic-only) recurrence. Gastroenterology 2020 Oct 29. (Epub ahead of print) (

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