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Circumferential submucosal incision prior to endoscopic mucosal resection versus conventional endoscopic mucosal resection for colorectal lesions with endoscopic features of sessile serrated lesions. | LitMetric

AI Article Synopsis

  • Sessile serrated lesions (SSLs) are tougher to completely remove compared to regular adenomas; this study looks into a method called circumferential submucosal incision prior to endoscopic mucosal resection (CSI-EMR) to improve removal rates.
  • The study involved analyzing 254 colorectal lesions and found that while CSI-EMR did not significantly enhance overall complete or en bloc resection rates compared to standard EMR, it did show a notably higher rate of R0 resections (complete removal with no cancer cells at the margins).
  • The CSI-EMR method took significantly longer to perform (over 6 minutes) compared to standard EMR (around 2.5 minutes), but both methods

Article Abstract

Background And Aims: Sessile serrated lesions (SSLs) are more prone to incomplete resection than conventional adenomas. This study evaluated whether circumferential submucosal incision prior to endoscopic mucosal resection (CSI-EMR) can increase the rate of complete and en bloc resections of colorectal lesions with endoscopic features of SSL.

Methods: Retrospective analyses and propensity score matching were performed for the resection of colorectal lesions ≥ 10 mm with endoscopic features of SSL.

Results: After 1:1 ratio matching, 127 lesions in the CSI-EMR group and 127 in the EMR group were selected for analysis. The median size of the lesions was 15 mm (IQR 12-16) in both groups. There was no significant difference in either the complete resection rate or en bloc resection rate between CSI-EMR and EMR groups (96.9% vs. 92.9%, P = 0.155; 92.1% vs. 89.0%, P = 0.391). By contrast, the R0 resection rate was significantly higher in the CSI-EMR group than in the EMR group (89.8% vs. 59.8%, P < 0.001). The median procedure time was significantly longer in the CSI-EMR group than in the EMR group (6.28 min vs. 2.55 min, P < 0.001), whereas there was no significant difference between the two groups in the incidence of adverse events or recurrence rate. Multivariate analysis showed that CSI-EMR was the only factor significantly associated with R0 resection (P < 0.001).

Conclusions: For colorectal lesions with endoscopic features of SSL, CSI-EMR does not increase the complete or en bloc resection rate, but does increase the R0 resection rate. The procedure time is longer for CSI-EMR than EMR. The association of CSI-EMR with R0 resection and non-recurrence should be further evaluated.

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Source
http://dx.doi.org/10.1007/s00464-021-08495-xDOI Listing

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