Safety of endoscopic mucosal resection (EMR) of large non-pedunculated colorectal adenomas in the elderly
Background Endoscopic mucosal resection (EMR) has been proven to be safe and effective for the treatment of colorectal adenomas. However, data are limited on the safety of this technique for large polyps and in elderly patients. Aims of our study were to examine the bleeding and perforation rates in...
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| Veröffentlicht in: | International journal of colorectal disease 2017-12, Vol.32 (12), p.1711-1717 |
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| container_title | International journal of colorectal disease |
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| creator | Bronsgeest, K. Huisman, J. F. Langers, A. Boonstra, J. J. Schenk, B. E. de Vos tot Nederveen Cappel, W. H. Vasen, H. F. A. Hardwick, J. C. H. |
| description | Background
Endoscopic mucosal resection (EMR) has been proven to be safe and effective for the treatment of colorectal adenomas. However, data are limited on the safety of this technique for large polyps and in elderly patients. Aims of our study were to examine the bleeding and perforation rates in patients with large non-pedunculated adenomas (≥20mm) and to evaluate the influence of size (≥40mm) and age (≥75 years) on the complication rates.
Methods
In this multicenter retrospective study, patients who underwent EMR of non-pedunculated adenomas ≥20mm between January 2012 and March 2016 were included. The demographics of the patients, the use of antithrombotic drugs, size of the polyps, type of resection, pathology report, occurrence of post-polypectomy bleeding, and perforation- and recurrence rate were collected.
Results
In 343 patients, 412 adenomas were removed. Eighty patients (23.3%) were ≥75 years of age, 138 polyps (33.5%) were ≥40mm. Bleeding complications were observed in 28 cases (6.8%) and were found significantly more frequent in adenomas ≥40mm, independent of the use of antithrombotic therapy. Five perforations (1.2%) were described, not related to the size of the polyp. There was no significant difference in complication rates between patients |
| doi_str_mv | 10.1007/s00384-017-2892-7 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5691088</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A714488463</galeid><sourcerecordid>A714488463</sourcerecordid><originalsourceid>FETCH-LOGICAL-c537t-fe31c2818de0ad3881aeadee1c60b9ac8a160d2bd11b2ab1b44381dd67cc269c3</originalsourceid><addsrcrecordid>eNp1kk1vFSEUhonR2Gv1B7gxJG7qYiqHYWaYjUnT1I-kxsSPNWHgzC0NA1eYaXL_vUxura3RsCBwnveFAy8hL4GdAmPd28xYLUXFoKu47HnVPSIbEDWvgLf8MdmUQl9B38gj8izna1bWbSeekiMupRScNxvivukR5z2NI8VgYzZx5wydFhOz9jRhRjO7GOjJxeevb1bK67RFGmKodmiXYBavZ7TURB9TYYtIWwxx0pm6QOcrpOgtJr9_Tp6M2md8cTsfkx_vL76ff6wuv3z4dH52WZmm7uZqxBoMlyAtMm1rKUFjcUQwLRt6baSGllk-WICB6wEGIWoJ1radMbztTX1M3h18d8swoTUY5qS92iU36bRXUTv1sBLcldrGG9W0PTApi8HJrUGKPxfMs5pcNui9DhiXrKCvu4ZzyUVBX_-FXsclhdJeodqGiXKj-g-11R6VC2Ms55rVVJ11IET5i3alTv9BlWFxciYGHF3ZfyCAg8CkmHPC8a5HYGrNhzrkQ5VvV2s-VFc0r-4_zp3idyAKwA9ALqWwxXSvo_-6_gLKR8Y_</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1965042693</pqid></control><display><type>article</type><title>Safety of endoscopic mucosal resection (EMR) of large non-pedunculated colorectal adenomas in the elderly</title><source>SpringerLink_现刊</source><creator>Bronsgeest, K. ; Huisman, J. F. ; Langers, A. ; Boonstra, J. J. ; Schenk, B. E. ; de Vos tot Nederveen Cappel, W. H. ; Vasen, H. F. A. ; Hardwick, J. C. H.</creator><creatorcontrib>Bronsgeest, K. ; Huisman, J. F. ; Langers, A. ; Boonstra, J. J. ; Schenk, B. E. ; de Vos tot Nederveen Cappel, W. H. ; Vasen, H. F. A. ; Hardwick, J. C. H.</creatorcontrib><description>Background
Endoscopic mucosal resection (EMR) has been proven to be safe and effective for the treatment of colorectal adenomas. However, data are limited on the safety of this technique for large polyps and in elderly patients. Aims of our study were to examine the bleeding and perforation rates in patients with large non-pedunculated adenomas (≥20mm) and to evaluate the influence of size (≥40mm) and age (≥75 years) on the complication rates.
Methods
In this multicenter retrospective study, patients who underwent EMR of non-pedunculated adenomas ≥20mm between January 2012 and March 2016 were included. The demographics of the patients, the use of antithrombotic drugs, size of the polyps, type of resection, pathology report, occurrence of post-polypectomy bleeding, and perforation- and recurrence rate were collected.
Results
In 343 patients, 412 adenomas were removed. Eighty patients (23.3%) were ≥75 years of age, 138 polyps (33.5%) were ≥40mm. Bleeding complications were observed in 28 cases (6.8%) and were found significantly more frequent in adenomas ≥40mm, independent of the use of antithrombotic therapy. Five perforations (1.2%) were described, not related to the size of the polyp. There was no significant difference in complication rates between patients <75 years and patients ≥75 years. Bleeding complications rates were significantly higher in patients receiving double antithrombotic therapy.
Conclusion
EMR is safe in elderly patients. EMR of adenomas of ≥40mm was associated with more bleeding complications. Future studies should address how the bleeding rates can be reduced in these patients, especially in those who use double antithrombotic treatment.</description><identifier>ISSN: 0179-1958</identifier><identifier>EISSN: 1432-1262</identifier><identifier>DOI: 10.1007/s00384-017-2892-7</identifier><identifier>PMID: 28884225</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Aged patients ; Bleeding ; Care and treatment ; Demography ; Drugs ; Electronic records ; Endoscopy ; Gastroenterology ; Geriatrics ; Hepatology ; Internal Medicine ; Medical research ; Medicine ; Medicine & Public Health ; Medicine, Experimental ; Mucosa ; Original ; Original Article ; Polyps ; Proctology ; Safety and security measures ; Surgery ; Tumors</subject><ispartof>International journal of colorectal disease, 2017-12, Vol.32 (12), p.1711-1717</ispartof><rights>The Author(s) 2017</rights><rights>COPYRIGHT 2017 Springer</rights><rights>International Journal of Colorectal Disease is a copyright of Springer, (2017). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c537t-fe31c2818de0ad3881aeadee1c60b9ac8a160d2bd11b2ab1b44381dd67cc269c3</citedby><cites>FETCH-LOGICAL-c537t-fe31c2818de0ad3881aeadee1c60b9ac8a160d2bd11b2ab1b44381dd67cc269c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00384-017-2892-7$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00384-017-2892-7$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28884225$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bronsgeest, K.</creatorcontrib><creatorcontrib>Huisman, J. F.</creatorcontrib><creatorcontrib>Langers, A.</creatorcontrib><creatorcontrib>Boonstra, J. J.</creatorcontrib><creatorcontrib>Schenk, B. E.</creatorcontrib><creatorcontrib>de Vos tot Nederveen Cappel, W. H.</creatorcontrib><creatorcontrib>Vasen, H. F. A.</creatorcontrib><creatorcontrib>Hardwick, J. C. H.</creatorcontrib><title>Safety of endoscopic mucosal resection (EMR) of large non-pedunculated colorectal adenomas in the elderly</title><title>International journal of colorectal disease</title><addtitle>Int J Colorectal Dis</addtitle><addtitle>Int J Colorectal Dis</addtitle><description>Background
Endoscopic mucosal resection (EMR) has been proven to be safe and effective for the treatment of colorectal adenomas. However, data are limited on the safety of this technique for large polyps and in elderly patients. Aims of our study were to examine the bleeding and perforation rates in patients with large non-pedunculated adenomas (≥20mm) and to evaluate the influence of size (≥40mm) and age (≥75 years) on the complication rates.
Methods
In this multicenter retrospective study, patients who underwent EMR of non-pedunculated adenomas ≥20mm between January 2012 and March 2016 were included. The demographics of the patients, the use of antithrombotic drugs, size of the polyps, type of resection, pathology report, occurrence of post-polypectomy bleeding, and perforation- and recurrence rate were collected.
Results
In 343 patients, 412 adenomas were removed. Eighty patients (23.3%) were ≥75 years of age, 138 polyps (33.5%) were ≥40mm. Bleeding complications were observed in 28 cases (6.8%) and were found significantly more frequent in adenomas ≥40mm, independent of the use of antithrombotic therapy. Five perforations (1.2%) were described, not related to the size of the polyp. There was no significant difference in complication rates between patients <75 years and patients ≥75 years. Bleeding complications rates were significantly higher in patients receiving double antithrombotic therapy.
Conclusion
EMR is safe in elderly patients. EMR of adenomas of ≥40mm was associated with more bleeding complications. Future studies should address how the bleeding rates can be reduced in these patients, especially in those who use double antithrombotic treatment.</description><subject>Aged patients</subject><subject>Bleeding</subject><subject>Care and treatment</subject><subject>Demography</subject><subject>Drugs</subject><subject>Electronic records</subject><subject>Endoscopy</subject><subject>Gastroenterology</subject><subject>Geriatrics</subject><subject>Hepatology</subject><subject>Internal Medicine</subject><subject>Medical research</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Medicine, Experimental</subject><subject>Mucosa</subject><subject>Original</subject><subject>Original Article</subject><subject>Polyps</subject><subject>Proctology</subject><subject>Safety and security measures</subject><subject>Surgery</subject><subject>Tumors</subject><issn>0179-1958</issn><issn>1432-1262</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kk1vFSEUhonR2Gv1B7gxJG7qYiqHYWaYjUnT1I-kxsSPNWHgzC0NA1eYaXL_vUxura3RsCBwnveFAy8hL4GdAmPd28xYLUXFoKu47HnVPSIbEDWvgLf8MdmUQl9B38gj8izna1bWbSeekiMupRScNxvivukR5z2NI8VgYzZx5wydFhOz9jRhRjO7GOjJxeevb1bK67RFGmKodmiXYBavZ7TURB9TYYtIWwxx0pm6QOcrpOgtJr9_Tp6M2md8cTsfkx_vL76ff6wuv3z4dH52WZmm7uZqxBoMlyAtMm1rKUFjcUQwLRt6baSGllk-WICB6wEGIWoJ1radMbztTX1M3h18d8swoTUY5qS92iU36bRXUTv1sBLcldrGG9W0PTApi8HJrUGKPxfMs5pcNui9DhiXrKCvu4ZzyUVBX_-FXsclhdJeodqGiXKj-g-11R6VC2Ms55rVVJ11IET5i3alTv9BlWFxciYGHF3ZfyCAg8CkmHPC8a5HYGrNhzrkQ5VvV2s-VFc0r-4_zp3idyAKwA9ALqWwxXSvo_-6_gLKR8Y_</recordid><startdate>20171201</startdate><enddate>20171201</enddate><creator>Bronsgeest, K.</creator><creator>Huisman, J. F.</creator><creator>Langers, A.</creator><creator>Boonstra, J. J.</creator><creator>Schenk, B. E.</creator><creator>de Vos tot Nederveen Cappel, W. H.</creator><creator>Vasen, H. F. A.</creator><creator>Hardwick, J. C. H.</creator><general>Springer Berlin Heidelberg</general><general>Springer</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20171201</creationdate><title>Safety of endoscopic mucosal resection (EMR) of large non-pedunculated colorectal adenomas in the elderly</title><author>Bronsgeest, K. ; Huisman, J. F. ; Langers, A. ; Boonstra, J. J. ; Schenk, B. E. ; de Vos tot Nederveen Cappel, W. H. ; Vasen, H. F. A. ; Hardwick, J. C. H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c537t-fe31c2818de0ad3881aeadee1c60b9ac8a160d2bd11b2ab1b44381dd67cc269c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aged patients</topic><topic>Bleeding</topic><topic>Care and treatment</topic><topic>Demography</topic><topic>Drugs</topic><topic>Electronic records</topic><topic>Endoscopy</topic><topic>Gastroenterology</topic><topic>Geriatrics</topic><topic>Hepatology</topic><topic>Internal Medicine</topic><topic>Medical research</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Medicine, Experimental</topic><topic>Mucosa</topic><topic>Original</topic><topic>Original Article</topic><topic>Polyps</topic><topic>Proctology</topic><topic>Safety and security measures</topic><topic>Surgery</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bronsgeest, K.</creatorcontrib><creatorcontrib>Huisman, J. F.</creatorcontrib><creatorcontrib>Langers, A.</creatorcontrib><creatorcontrib>Boonstra, J. J.</creatorcontrib><creatorcontrib>Schenk, B. E.</creatorcontrib><creatorcontrib>de Vos tot Nederveen Cappel, W. H.</creatorcontrib><creatorcontrib>Vasen, H. F. A.</creatorcontrib><creatorcontrib>Hardwick, J. C. H.</creatorcontrib><collection>SpringerOpen</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Immunology Abstracts</collection><collection>ProQuest_Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest Central (New)</collection><collection>ProQuest One Academic (New)</collection><collection>ProQuest Health & Medical Research Collection</collection><collection>ProQuest One Academic Middle East (New)</collection><collection>ProQuest One Health & Nursing</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>International journal of colorectal disease</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bronsgeest, K.</au><au>Huisman, J. F.</au><au>Langers, A.</au><au>Boonstra, J. J.</au><au>Schenk, B. E.</au><au>de Vos tot Nederveen Cappel, W. H.</au><au>Vasen, H. F. A.</au><au>Hardwick, J. C. H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Safety of endoscopic mucosal resection (EMR) of large non-pedunculated colorectal adenomas in the elderly</atitle><jtitle>International journal of colorectal disease</jtitle><stitle>Int J Colorectal Dis</stitle><addtitle>Int J Colorectal Dis</addtitle><date>2017-12-01</date><risdate>2017</risdate><volume>32</volume><issue>12</issue><spage>1711</spage><epage>1717</epage><pages>1711-1717</pages><issn>0179-1958</issn><eissn>1432-1262</eissn><abstract>Background
Endoscopic mucosal resection (EMR) has been proven to be safe and effective for the treatment of colorectal adenomas. However, data are limited on the safety of this technique for large polyps and in elderly patients. Aims of our study were to examine the bleeding and perforation rates in patients with large non-pedunculated adenomas (≥20mm) and to evaluate the influence of size (≥40mm) and age (≥75 years) on the complication rates.
Methods
In this multicenter retrospective study, patients who underwent EMR of non-pedunculated adenomas ≥20mm between January 2012 and March 2016 were included. The demographics of the patients, the use of antithrombotic drugs, size of the polyps, type of resection, pathology report, occurrence of post-polypectomy bleeding, and perforation- and recurrence rate were collected.
Results
In 343 patients, 412 adenomas were removed. Eighty patients (23.3%) were ≥75 years of age, 138 polyps (33.5%) were ≥40mm. Bleeding complications were observed in 28 cases (6.8%) and were found significantly more frequent in adenomas ≥40mm, independent of the use of antithrombotic therapy. Five perforations (1.2%) were described, not related to the size of the polyp. There was no significant difference in complication rates between patients <75 years and patients ≥75 years. Bleeding complications rates were significantly higher in patients receiving double antithrombotic therapy.
Conclusion
EMR is safe in elderly patients. EMR of adenomas of ≥40mm was associated with more bleeding complications. Future studies should address how the bleeding rates can be reduced in these patients, especially in those who use double antithrombotic treatment.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>28884225</pmid><doi>10.1007/s00384-017-2892-7</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged patients Bleeding Care and treatment Demography Drugs Electronic records Endoscopy Gastroenterology Geriatrics Hepatology Internal Medicine Medical research Medicine Medicine & Public Health Medicine, Experimental Mucosa Original Original Article Polyps Proctology Safety and security measures Surgery Tumors |
| title | Safety of endoscopic mucosal resection (EMR) of large non-pedunculated colorectal adenomas in the elderly |
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