Long-term adenoma recurrence following wide-field endoscopic mucosal resection (WF-EMR) for advanced colonic mucosal neoplasia is infrequent: results and risk factors in 1000 cases from the Australian Colonic EMR (ACE) study
Long-term adenoma recurrence following wide-field endoscopic mucosal resection (WF-EMR) for advanced colonic mucosal neoplasia is infrequent: results and risk factors in 1000 cases from the Australian Colonic EMR (ACE) study
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DOI：
10.1136/gutjnl-2013-305516
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发表时间：
2015-01-01
期刊：
影响因子：
24.5
通讯作者：
Bourke, Michael J.
中科院分区：
文献类型：
--
作者：
Moss, Alan;Williams, Stephen J.;Bourke, Michael J.
目的宽野内窥镜黏膜切除术(WF-EMR)是治疗直径达120 mm的晚期结肠粘膜肿瘤的一种替代手术，但因其潜在的高复发率而受到批评。我们的目标是量化成功的WF-EMR后4个月(早期)和16个月(晚期)的复发，并确定其危险因素和临床意义。设计正在进行的多中心、前瞻性、意向治疗分析，对无梗或侧向扩散的结肠病变进行研究，将其应用于WF-EMR的7个学术内窥镜单位。在WF-EMR后4个月(SC1)和16个月(SC2)分别进行监视结肠镜检查(SC)，并进行影像记录和瘢痕活检。结果共纳入1134例患者，共获得1000个结肠镜检查成功，其中799例接受了SC1检查。670例正常。早期复发/残留腺瘤128例(16.0%，95%CI 13.6%~18.7%)。其中一例不明。71.7%的患者腺瘤复发/残留较小。在多变量分析中，危险因素是病变大小<40 mm、使用Ar等离子凝固术和术中出血。在670例SC1正常的患者中，426例接受了SC2治疗，其中17例出现晚期复发(4.0%，95%可信区间2.4%~6.2%)。总体而言，145例患者中，135例复发/残留腺瘤治疗成功(93.1%，95%可信区间88.1%至96.4%)。如果最初的EMR被认为是成功的，并且没有需要手术的黏膜下侵犯，98.1%(95%CI 96.6%~99.0%)的腺瘤是无瘤的，并且在EMR后16个月已经避免了手术。结论结肠WF-EMR术后早期复发/残留腺瘤的发生率为16%，且通常是单灶性的且较小。确定了危险因素。晚期复发率为4%。总体而言，93%的病例通过内窥镜治疗复发。WF-EMR术后复发不是一个重要的临床问题，因为有严格的结肠镜监测，可以通过内窥镜进行治疗，成功率很高。
Objective Wide-field endoscopic mucosal resection (WF-EMR) is an alternative to surgery for treatment of advanced colonic mucosal neoplasia up to 120 mm in size, but has been criticised for its potentially high recurrence rates. We aimed to quantify recurrence at 4 months (early) and 16 months (late) following successful WF-EMR and identify its risk factors and clinical significance.Design Ongoing multicentre, prospective, intention-to-treat analysis of sessile or laterally spreading colonic lesions >= 20 mm in size referred for WF-EMR to seven academic endoscopy units. Surveillance colonoscopy (SC) was performed 4 months (SC1) and 16 months (SC2) after WF-EMR, with photographic documentation and biopsy of the scar.Results 1134 consecutive patients were enrolled when 1000 successful EMRs were achieved, of whom 799 have undergone SC1. 670 were normal. Early recurrent/residual adenoma was present in 128 (16.0%, 95% CI 13.6% to 18.7%). One case was unknown. The recurrent/residual adenoma was diminutive in 71.7% of cases. On multivariable analysis, risk factors were lesion size >40 mm, use of argon plasma coagulation and intraprocedural bleeding. Of 670 with normal SC1, 426 have undergone SC2, with late recurrence present in 17 cases (4.0%, 95% CI 2.4% to 6.2%). Overall, recurrent/residual adenoma was successfully treated endoscopically in 135 of 145 cases (93.1%, 95% CI 88.1% to 96.4%). If the initial EMR was deemed successful and did not contain submucosal invasion requiring surgery, 98.1% (95% CI 96.6% to 99.0%) were adenoma-free and had avoided surgery at 16 months following EMR.Conclusions Following colonic WF-EMR, early recurrent/residual adenoma occurs in 16%, and is usually unifocal and diminutive. Risk factors were identified. Late recurrence occurs in 4%. Overall, recurrence was managed endoscopically in 93% of cases. Recurrence is not a significant clinical problem following WF-EMR, as with strict colonoscopic surveillance, it can be managed endoscopically with high success rates.