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Risk factor for recurrence after endoscopic mucosal resection of colorectal lesions

The latest issue of Endoscopy reviews local recurrence after endoscopic mucosal resection of nonpedunculated colorectal lesions.

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Local recurrence has been observed after endoscopic mucosal resection (EMR) of nonpedunculated colorectal lesions.

The indications for follow-up colonoscopy and the optimal time interval are currently unclear.

Dr Tim Belderbos and colleagues from the Netherlands performed a systematic review to assess the frequency of local recurrence after EMR, to identify risk factors for recurrence, and to provide follow-up recommendations.

A literature search was performed in PubMed, EMBASE, and the Cochrane Library.

EMR was defined as endoscopic snare resection after submucosal fluid injection for removal of nonpedunculated adenomas and early carcinomas.

The research team subdivided local recurrence into early recurrence, and late recurrence.

The mean recurrence risk after EMR was 15%
Endoscopy

A random effects meta-analysis was performed to calculate the pooled estimate of risk of recurrence.

The research team included a total of 33 studies.

The mean recurrence risk after EMR was 15%.

Recurrence risk was higher after piecemeal resection than after en bloc resection.

In 15 studies that differentiated between early and late recurrences, the team found that 88% of recurrences occurred early.

In 4 studies with follow-up at 3, 6, and ≥ 12 months, 76% of recurrences were detected at 3 months, increasing to 96% at 6 months.

The team found that only piecemeal resection was associated with recurrence.

Dr Belderbos' team commented, "Local recurrence after EMR of nonpedunculated colorectal lesions occurs in 3% of en bloc resections, and 20% of piecemeal resections."

"Piecemeal resection was the only independent risk factor for recurrence."

"As more than 90% of recurrences are detected at 6 months after EMR, we propose that 6 months is the optimal initial follow-up interval."

Endoscopy 2014; 46(05): 388-402
05 May 2014

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