Outcomes of Deep Mural Injury After Endoscopic Resection: An International Cohort of 3717 Large Non-Pedunculated Colorectal Polyps.

Cohort Studies Colonic Polyps / etiology Colonoscopy / adverse effects Colorectal Neoplasms / etiology Endoscopic Mucosal Resection / adverse effects Humans
Adverse Event Colonoscopy Complication Endoscopy Perforation

Journal

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
ISSN: 1542-7714
Titre abrégé: Clin Gastroenterol Hepatol
Pays: United States
ID NLM: 101160775

Informations de publication

Date de publication:
02 2022
Historique:
received: 15 10 2020
revised: 31 12 2020
accepted: 05 01 2021
pubmed: 11 1 2021
medline: 17 3 2022
entrez: 10 1 2021
Statut: ppublish

Résumé

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.

Sections du résumé

BACKGROUND & AIMS
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).
METHODS
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).
RESULTS
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.
CONCLUSIONS
Significant DMI is readily managed endoscopically and does not appear to affect technical success or recurrence.

Identifiants

DOI: 10.1016/j.cgh.2021.01.007 PMID: 33422686
pubmed: 33422686
pii: S1542-3565(21)00009-4
doi: 10.1016/j.cgh.2021.01.007
pii:
doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

e139-e147

Commentaires et corrections

Type : CommentIn

Informations de copyright

Copyright © 2022 AGA Institute. Published by Elsevier Inc. All rights reserved.

Auteurs

Iddo Bar-Yishay (I)

Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, Australia.

Neal Shahidi (N)

Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, Australia; Westmead Clinical School, University of Sydney, Sydney, Australia; University of British Columbia, Department of Medicine, Vancouver, Canada.

Sunil Gupta (S)

Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, Australia; Westmead Clinical School, University of Sydney, Sydney, Australia.

Sergei Vosko (S)

Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, Australia.

W Arnout van Hattem (WA)

Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, Australia.

Scott Schoeman (S)

Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, Australia.

Mayenaaz Sidhu (M)

Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, Australia; Westmead Clinical School, University of Sydney, Sydney, Australia.

David J Tate (DJ)

Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, Australia; University Hospital of Ghent, Ghent, Belgium.

Luke F Hourigan (LF)

Princess Alexandra Hospital, Department of Gastroenterology and Hepatology, Brisbane, Australia; The University of Queensland and Greenslopes Private Hospital, Gallipoli Medical Research Institute, School of Medicine, Brisbane, Australia.

Rajvinder Singh (R)

Lyell McEwan Hospital, Department of Gastroenterology and Hepatology, Adelaide, Australia.

Alan Moss (A)

Western Health, Department of Endoscopic Services, Melbourne, Australia.

Spiro C Raftopoulos (SC)

Sir Charles Gairdner Hospital, Department of Gastroenterology and Hepatology, Perth, Australia.

Gregor Brown (G)

The Epworth Hospital, Department of Gastroenterology, Melbourne, Australia; The Alfred Hospital, Department of Gastroenterology and Hepatology, Melbourne, Australia.

Simon Zanati (S)

Western Health, Department of Endoscopic Services, Melbourne, Australia; The Alfred Hospital, Department of Gastroenterology and Hepatology, Melbourne, Australia.

Steven J Heitman (SJ)

University of Calgary, Cumming School of Medicine, Department of Medicine, Calgary, Canada.

Eric Y T Lee (EYT)

Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, Australia; Westmead Clinical School, University of Sydney, Sydney, Australia.

Nicholas Burgess (N)

Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, Australia; Westmead Clinical School, University of Sydney, Sydney, Australia.

Stephen J Williams (SJ)

Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, Australia; Westmead Clinical School, University of Sydney, Sydney, Australia.

Karen Byth (K)

University of Sydney, National Health and Medical Research Council Clinical Trials Centre, Sydney, Australia; Westmead Hospital, Western Sydney Local Health District Research and Education Network, Sydney, Australia.

Michael J Bourke (MJ)

Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, Australia; Westmead Clinical School, University of Sydney, Sydney, Australia. Electronic address: michael@citywestgastro.com.au.

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Classifications MeSH

questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Outcomes of Deep Mural Injury After Endoscopic...
questionsmedicales.fr › États, signes et symptômes pathologiques › États anatomopathologiques › Polypes › Polypes intestinaux › Polypes coliques › Outcomes of Deep Mural Injury After Endoscopic...
questionsmedicales.fr › Procédures de chirurgie opératoire › Interventions chirurgicales mini-invasives › Endoscopie › Endoscopie digestive › Endoscopie gastrointestinale › Coloscopie › Outcomes of Deep Mural Injury After Endoscopic...
questionsmedicales.fr › Maladies de l'appareil digestif › Maladies gastro-intestinales › Maladies intestinales › Maladies du rectum › Tumeurs colorectales › Outcomes of Deep Mural Injury After Endoscopic...
questionsmedicales.fr › Procédures de chirurgie opératoire › Interventions chirurgicales mini-invasives › Endoscopie › Endoscopie digestive › Endoscopie gastrointestinale › Mucosectomie endoscopique › Outcomes of Deep Mural Injury After Endoscopic...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Outcomes of Deep Mural Injury After Endoscopic...