Outcomes of Deep Mural Injury After Endoscopic Resection: An International Cohort of 3717 Large Non-Pedunculated Colorectal Polyps
Although perforation is the most feared adverse event associated with endoscopic mucosal resection (EMR), limited data exists concerning its management. Therefore, we sought to evaluate the short- and long-term outcomes of intra-procedural deep mural injury (DMI) in an international multi-center obs...
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Veröffentlicht in: | Clinical gastroenterology and hepatology 2022-02, Vol.20 (2), p.e139-e147 |
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creator | Bar-Yishay, Iddo Shahidi, Neal Gupta, Sunil Vosko, Sergei van Hattem, W. Arnout Schoeman, Scott Sidhu, Mayenaaz Tate, David J. Hourigan, Luke F. Singh, Rajvinder Moss, Alan Raftopoulos, Spiro C. Brown, Gregor Zanati, Simon Heitman, Steven J. Lee, Eric Y.T. Burgess, Nicholas Williams, Stephen J. Byth, Karen Bourke, Michael J. |
description | Although perforation is the most feared adverse event associated with endoscopic mucosal resection (EMR), limited data exists concerning its management. Therefore, we sought to evaluate the short- and long-term outcomes of intra-procedural deep mural injury (DMI) in an international multi-center observational cohort of large (≥20 mm) non-pedunculated colorectal polyps (LNPCPs).
Consecutive patients who underwent EMR for a LNPCP ≥20 mm were evaluated. Significant DMI (S-DMI) was defined as Sydney DMI Classification type III (muscularis propria injury, target sign) or type IV/V (perforation without or with contamination, respectively). The primary outcome was successful S-DMI defect closure. Secondary outcomes included technical success (removal of all visible polypoid tissue during index EMR), surgical referral and recurrence at first surveillance colonscopy (SC1).
Between July 2008 to May 2020, 3717 LNPCPs underwent EMR. Median lesion size was 35mm (interquartile range (IQR) 25 to 45mm). Significant DMI was identified in 101 cases (2.7%), with successful defect closure in 98 (97.0%) using a median of 4 through-the-scope clips (TTSCs; IQR 3 to 6 TTSCs). Three (3.0%) patients underwent S-DMI-related urgent surgery. Technical success was achieved in 94 (93.1%) patients, with 46 (45.5%) admitted to hospital (median duration 1 day; IQR 1 to 2 days). Comparing LNPCPs with and without S-DMI, no differences in technical success (94 (93.1%) vs 3316 (91.7%); P = .62) or SC1 recurrence (12 (20.0%) vs 363 (13.6%); P = .15) were identified.
Significant DMI is readily managed endoscopically and does not appear to affect technical success or recurrence.
[Display omitted] |
doi_str_mv | 10.1016/j.cgh.2021.01.007 |
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Consecutive patients who underwent EMR for a LNPCP ≥20 mm were evaluated. Significant DMI (S-DMI) was defined as Sydney DMI Classification type III (muscularis propria injury, target sign) or type IV/V (perforation without or with contamination, respectively). The primary outcome was successful S-DMI defect closure. Secondary outcomes included technical success (removal of all visible polypoid tissue during index EMR), surgical referral and recurrence at first surveillance colonscopy (SC1).
Between July 2008 to May 2020, 3717 LNPCPs underwent EMR. Median lesion size was 35mm (interquartile range (IQR) 25 to 45mm). Significant DMI was identified in 101 cases (2.7%), with successful defect closure in 98 (97.0%) using a median of 4 through-the-scope clips (TTSCs; IQR 3 to 6 TTSCs). Three (3.0%) patients underwent S-DMI-related urgent surgery. Technical success was achieved in 94 (93.1%) patients, with 46 (45.5%) admitted to hospital (median duration 1 day; IQR 1 to 2 days). Comparing LNPCPs with and without S-DMI, no differences in technical success (94 (93.1%) vs 3316 (91.7%); P = .62) or SC1 recurrence (12 (20.0%) vs 363 (13.6%); P = .15) were identified.
Significant DMI is readily managed endoscopically and does not appear to affect technical success or recurrence.
[Display omitted]</description><identifier>ISSN: 1542-3565</identifier><identifier>EISSN: 1542-7714</identifier><identifier>DOI: 10.1016/j.cgh.2021.01.007</identifier><identifier>PMID: 33422686</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adverse Event ; Cohort Studies ; Colonic Polyps - etiology ; Colonic Polyps - surgery ; Colonoscopy ; Colonoscopy - adverse effects ; Colorectal Neoplasms - etiology ; Complication ; Endoscopic Mucosal Resection - adverse effects ; Endoscopy ; Humans ; Perforation</subject><ispartof>Clinical gastroenterology and hepatology, 2022-02, Vol.20 (2), p.e139-e147</ispartof><rights>2022 AGA Institute</rights><rights>Copyright © 2022 AGA Institute. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c353t-e603e5283af870df57ceefd662874c1fa6405205af16f83a33fcfb454279cc5f3</citedby><cites>FETCH-LOGICAL-c353t-e603e5283af870df57ceefd662874c1fa6405205af16f83a33fcfb454279cc5f3</cites><orcidid>0000-0001-5047-312X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1542356521000094$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33422686$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bar-Yishay, Iddo</creatorcontrib><creatorcontrib>Shahidi, Neal</creatorcontrib><creatorcontrib>Gupta, Sunil</creatorcontrib><creatorcontrib>Vosko, Sergei</creatorcontrib><creatorcontrib>van Hattem, W. Arnout</creatorcontrib><creatorcontrib>Schoeman, Scott</creatorcontrib><creatorcontrib>Sidhu, Mayenaaz</creatorcontrib><creatorcontrib>Tate, David J.</creatorcontrib><creatorcontrib>Hourigan, Luke F.</creatorcontrib><creatorcontrib>Singh, Rajvinder</creatorcontrib><creatorcontrib>Moss, Alan</creatorcontrib><creatorcontrib>Raftopoulos, Spiro C.</creatorcontrib><creatorcontrib>Brown, Gregor</creatorcontrib><creatorcontrib>Zanati, Simon</creatorcontrib><creatorcontrib>Heitman, Steven J.</creatorcontrib><creatorcontrib>Lee, Eric Y.T.</creatorcontrib><creatorcontrib>Burgess, Nicholas</creatorcontrib><creatorcontrib>Williams, Stephen J.</creatorcontrib><creatorcontrib>Byth, Karen</creatorcontrib><creatorcontrib>Bourke, Michael J.</creatorcontrib><title>Outcomes of Deep Mural Injury After Endoscopic Resection: An International Cohort of 3717 Large Non-Pedunculated Colorectal Polyps</title><title>Clinical gastroenterology and hepatology</title><addtitle>Clin Gastroenterol Hepatol</addtitle><description>Although perforation is the most feared adverse event associated with endoscopic mucosal resection (EMR), limited data exists concerning its management. Therefore, we sought to evaluate the short- and long-term outcomes of intra-procedural deep mural injury (DMI) in an international multi-center observational cohort of large (≥20 mm) non-pedunculated colorectal polyps (LNPCPs).
Consecutive patients who underwent EMR for a LNPCP ≥20 mm were evaluated. Significant DMI (S-DMI) was defined as Sydney DMI Classification type III (muscularis propria injury, target sign) or type IV/V (perforation without or with contamination, respectively). The primary outcome was successful S-DMI defect closure. Secondary outcomes included technical success (removal of all visible polypoid tissue during index EMR), surgical referral and recurrence at first surveillance colonscopy (SC1).
Between July 2008 to May 2020, 3717 LNPCPs underwent EMR. Median lesion size was 35mm (interquartile range (IQR) 25 to 45mm). Significant DMI was identified in 101 cases (2.7%), with successful defect closure in 98 (97.0%) using a median of 4 through-the-scope clips (TTSCs; IQR 3 to 6 TTSCs). Three (3.0%) patients underwent S-DMI-related urgent surgery. Technical success was achieved in 94 (93.1%) patients, with 46 (45.5%) admitted to hospital (median duration 1 day; IQR 1 to 2 days). Comparing LNPCPs with and without S-DMI, no differences in technical success (94 (93.1%) vs 3316 (91.7%); P = .62) or SC1 recurrence (12 (20.0%) vs 363 (13.6%); P = .15) were identified.
Significant DMI is readily managed endoscopically and does not appear to affect technical success or recurrence.
[Display omitted]</description><subject>Adverse Event</subject><subject>Cohort Studies</subject><subject>Colonic Polyps - etiology</subject><subject>Colonic Polyps - surgery</subject><subject>Colonoscopy</subject><subject>Colonoscopy - adverse effects</subject><subject>Colorectal Neoplasms - etiology</subject><subject>Complication</subject><subject>Endoscopic Mucosal Resection - adverse effects</subject><subject>Endoscopy</subject><subject>Humans</subject><subject>Perforation</subject><issn>1542-3565</issn><issn>1542-7714</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE9LHDEYh4Moaq0fwEvJ0cus-Z_ZelpW2wrbKqU9h5h5o7PMJmMyU9irn7wZdvUovJCEPL8fvA9CF5TMKKHqaj1zT88zRhidkTJEH6BTKgWrtKbicH_nUskT9CnnNSFsLub6GJ1wLhhTtTpFr_fj4OIGMo4e3wD0-OeYbIfvwnpMW7zwAyR8G5qYXexbh39DBje0MXzFi1Co8h3s9C6ZZXyOaZiKuKYar2x6AvwrhuoBmjG4sbMDNIXqYiodJfAQu22fP6Mjb7sM5_vzDP39dvtn-aNa3X-_Wy5WleOSDxUowkGymltfa9J4qR2Ab5RitRaOeqsEkYxI66nyheLcO_8oigI9d056foYud719ii8j5MFs2uyg62yAOGbDhFa1pFzwgtId6lLMOYE3fWo3Nm0NJWZSb9amqDeTekPKEF0yX_b14-MGmvfEm-sCXO8AKEv-ayGZ7FoIDpp28mGa2H5Q_x9ty5R-</recordid><startdate>202202</startdate><enddate>202202</enddate><creator>Bar-Yishay, Iddo</creator><creator>Shahidi, Neal</creator><creator>Gupta, Sunil</creator><creator>Vosko, Sergei</creator><creator>van Hattem, W. 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Arnout</au><au>Schoeman, Scott</au><au>Sidhu, Mayenaaz</au><au>Tate, David J.</au><au>Hourigan, Luke F.</au><au>Singh, Rajvinder</au><au>Moss, Alan</au><au>Raftopoulos, Spiro C.</au><au>Brown, Gregor</au><au>Zanati, Simon</au><au>Heitman, Steven J.</au><au>Lee, Eric Y.T.</au><au>Burgess, Nicholas</au><au>Williams, Stephen J.</au><au>Byth, Karen</au><au>Bourke, Michael J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes of Deep Mural Injury After Endoscopic Resection: An International Cohort of 3717 Large Non-Pedunculated Colorectal Polyps</atitle><jtitle>Clinical gastroenterology and hepatology</jtitle><addtitle>Clin Gastroenterol Hepatol</addtitle><date>2022-02</date><risdate>2022</risdate><volume>20</volume><issue>2</issue><spage>e139</spage><epage>e147</epage><pages>e139-e147</pages><issn>1542-3565</issn><eissn>1542-7714</eissn><abstract>Although perforation is the most feared adverse event associated with endoscopic mucosal resection (EMR), limited data exists concerning its management. Therefore, we sought to evaluate the short- and long-term outcomes of intra-procedural deep mural injury (DMI) in an international multi-center observational cohort of large (≥20 mm) non-pedunculated colorectal polyps (LNPCPs).
Consecutive patients who underwent EMR for a LNPCP ≥20 mm were evaluated. Significant DMI (S-DMI) was defined as Sydney DMI Classification type III (muscularis propria injury, target sign) or type IV/V (perforation without or with contamination, respectively). The primary outcome was successful S-DMI defect closure. Secondary outcomes included technical success (removal of all visible polypoid tissue during index EMR), surgical referral and recurrence at first surveillance colonscopy (SC1).
Between July 2008 to May 2020, 3717 LNPCPs underwent EMR. Median lesion size was 35mm (interquartile range (IQR) 25 to 45mm). Significant DMI was identified in 101 cases (2.7%), with successful defect closure in 98 (97.0%) using a median of 4 through-the-scope clips (TTSCs; IQR 3 to 6 TTSCs). Three (3.0%) patients underwent S-DMI-related urgent surgery. Technical success was achieved in 94 (93.1%) patients, with 46 (45.5%) admitted to hospital (median duration 1 day; IQR 1 to 2 days). Comparing LNPCPs with and without S-DMI, no differences in technical success (94 (93.1%) vs 3316 (91.7%); P = .62) or SC1 recurrence (12 (20.0%) vs 363 (13.6%); P = .15) were identified.
Significant DMI is readily managed endoscopically and does not appear to affect technical success or recurrence.
[Display omitted]</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>33422686</pmid><doi>10.1016/j.cgh.2021.01.007</doi><orcidid>https://orcid.org/0000-0001-5047-312X</orcidid></addata></record> |
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subjects | Adverse Event Cohort Studies Colonic Polyps - etiology Colonic Polyps - surgery Colonoscopy Colonoscopy - adverse effects Colorectal Neoplasms - etiology Complication Endoscopic Mucosal Resection - adverse effects Endoscopy Humans Perforation |
title | Outcomes of Deep Mural Injury After Endoscopic Resection: An International Cohort of 3717 Large Non-Pedunculated Colorectal Polyps |
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