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 20 February 2018

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News

New classification for perforation after colonic endoscopic mucosal resection

The most recent issue of Gut proposed a new classification for the appearance and integrity of the muscularis propria after endoscopic mucosal resection including various extents of deep mural injury.

News image

Perforation is the most serious complication associated with endoscopic mucosal resection.

Dr Nicholas Burgess and colleagues proposed a new classification for the appearance and integrity of the muscularis propria after endoscopic mucosal resection including various extents of deep mural injury.

Risk factors for these injuries were analyzed.

Endoscopic images and histological specimens of consecutive patients undergoing endoscopic mucosal resection of colonic laterally spreading lesions 20 mm or more at a large Australian tertiary referral endoscopy unit were retrospectively analyzed using our new deep mural injury classification system.

Deep mural injury was graded according to muscularis propria injury.

A clinically significant perforation occurred in less than 1% of patients
Gut

Histological specimens were examined for included muscularis propria and patient outcomes were recorded.

All type III–V deep mural injury signs were clipped if possible, types I and II deep mural injury were clipped at the endoscopists’ discretion.

The research team performed 911 lesions in 802 patients.

The team found that deep mural injury signs were identified in 10% of patients.

Type III–V deep mural injury was identified in 3% of patients.

Clipping was successfully performed in all patients.

A clinically significant perforation occurred in less than 1% of patients.

The research team observed that only one of the 59 type I/II cases experienced a delayed perforation.

The team noted that 86% of patients with DMI were discharged on the same day, all without sequelae.

The researchers found that type III–V deep mural injury was associated with transverse colon location, en bloc resection and high-grade dysplasia or submucosal invasive cancer.

Dr Burgess' team comments, "In this retrospective analysis, use of the new classification and management with clips appeared to be a safe approach."

"Advanced deep mural injury types occurred in 3% of patients, and were associated with identifiable risk factors.

Further prospective clinical studies should use this new classification."

Gut 2017;66:1779-1789
22 September 2017

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