Incomplete Mucosal Layer Excision during Endoscopic Mucosal Resection: a potential source of recurrent adenoma.

Journal

Gastrointestinal endoscopy
ISSN: 1097-6779
Titre abrégé: Gastrointest Endosc
Pays: United States
ID NLM: 0010505

Informations de publication

Date de publication:
25 Jan 2024
Historique:
received: 07 11 2023
revised: 29 12 2023
accepted: 22 01 2024
medline: 28 1 2024
pubmed: 28 1 2024
entrez: 27 1 2024
Statut: aheadofprint

Résumé

Residual or recurrent adenoma detected during surveillance (RRA) is the major limitation of endoscopic mucosal resection (EMR). The pathogenesis of RRA is unknown although thermal ablation of the post-EMR defect (PED) margin reduces RRA. We aimed to identify a feature within the PED which could be associated with RRA. Between 1/2017 and 7/2020 detailed prospective procedural data on all EMR procedures performed at a single centre were retrospectively analysed. At the completion of EMR the PED was systematically examined for features of incomplete mucosal layer excision (IME). This was defined as a demarcated area within the PED bordered by a white electrocautery ring, containing endoscopically identifiable features suggesting incomplete resection of the mucosa including lacy capillaries and/or visible fibres of the muscularis mucosae. Areas of IME were re-injected and re-excised by snare and submitted separately for blinded specialist gastrointestinal pathologist review. EMR was performed for 508 large non-pedunculated colorectal polyps (LNPCPs) (median size 35mm). In 10 PED (2.0%) an area of IME was identified and excised. Histopathological examination of areas of suspected IME demonstrated muscularis mucosae in 9/10 (90%), residual lamina propria in 9/10 (90.0%) and residual adenoma in 5/10 (50.0%). No RRA was detected during follow-up after re-excision of IME. We report the novel finding of IME within the PED after EMR of LNPCPs. IME may contain microscopic residual adenoma and therefore is a risk for RRA during follow-up. After completion of EMR the PED should be carefully evaluated and if IME is found it should be excised.

Sections du résumé

BACKGROUND AND AIMS OBJECTIVE
Residual or recurrent adenoma detected during surveillance (RRA) is the major limitation of endoscopic mucosal resection (EMR). The pathogenesis of RRA is unknown although thermal ablation of the post-EMR defect (PED) margin reduces RRA. We aimed to identify a feature within the PED which could be associated with RRA.
METHODS METHODS
Between 1/2017 and 7/2020 detailed prospective procedural data on all EMR procedures performed at a single centre were retrospectively analysed. At the completion of EMR the PED was systematically examined for features of incomplete mucosal layer excision (IME). This was defined as a demarcated area within the PED bordered by a white electrocautery ring, containing endoscopically identifiable features suggesting incomplete resection of the mucosa including lacy capillaries and/or visible fibres of the muscularis mucosae. Areas of IME were re-injected and re-excised by snare and submitted separately for blinded specialist gastrointestinal pathologist review.
RESULTS RESULTS
EMR was performed for 508 large non-pedunculated colorectal polyps (LNPCPs) (median size 35mm). In 10 PED (2.0%) an area of IME was identified and excised. Histopathological examination of areas of suspected IME demonstrated muscularis mucosae in 9/10 (90%), residual lamina propria in 9/10 (90.0%) and residual adenoma in 5/10 (50.0%). No RRA was detected during follow-up after re-excision of IME.
CONCLUSION CONCLUSIONS
We report the novel finding of IME within the PED after EMR of LNPCPs. IME may contain microscopic residual adenoma and therefore is a risk for RRA during follow-up. After completion of EMR the PED should be carefully evaluated and if IME is found it should be excised.

Identifiants

DOI: 10.1016/j.gie.2024.01.030 PMID: 38280532
pubmed: 38280532
pii: S0016-5107(24)00050-6
doi: 10.1016/j.gie.2024.01.030
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2024 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Auteurs

David J Tate (DJ)

Westmead Hospital, Gastroenterology and Hepatology (Sydney, NSW, Australia); University of Sydney, Medical School (Westmead, New South Wales, Australia); Faculty of Health Sciences, University of Ghent (Ghent, Belgium).

Sergei Vosko (S)

Westmead Hospital, Gastroenterology and Hepatology (Sydney, NSW, Australia).

Iddo Bar-Yishay (I)

Westmead Hospital, Gastroenterology and Hepatology (Sydney, NSW, Australia).

Lobke Desomer (L)

Westmead Hospital, Gastroenterology and Hepatology (Sydney, NSW, Australia); AZ Delta Hospital, Roeselare (Roeselare, Belgium).

Neal Shahidi (N)

Westmead Hospital, Gastroenterology and Hepatology (Sydney, NSW, Australia).

Mayenaaz Sidhu (M)

Westmead Hospital, Gastroenterology and Hepatology (Sydney, NSW, Australia).

Duncan McLeod (D)

ICPMR, Department of Pathology (Sydney, New South Wales, Australia).

Michael J Bourke (MJ)

Westmead Hospital, Gastroenterology and Hepatology (Sydney, NSW, Australia); University of Sydney, Medical School (Westmead, New South Wales, Australia). Electronic address: michael@citywestgastro.com.au.

Classifications MeSH