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
Hauptverfasser: 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.
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container_end_page 1717
container_issue 12
container_start_page 1711
container_title International journal of colorectal disease
container_volume 32
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
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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 &lt;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 &amp; 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 &lt;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 &amp; 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. 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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 &lt;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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