For Left-Sided Colon Lesions up to 25 mm and Right-Sided Colon Lesions up to 20 mm, Piecemeal EMR Is as Good as en Bloc Resection

Douglas K. Rex, MD, FASGE reviewing Tate DJ, et al. Gastrointest Endosc 2019 Dec 27.

Advanced endoscopists are often tempted to remove laterally spreading lesions (LSLs) up to 25 mm in size en bloc, which provides a better pathologic specimen, and in cases of superficial submucosal invasion (SMI) of cancer, may allow patients to avoid surgery. 

In the current study, LSLs up to 25 mm in the left colon and up to 20 mm in the right colon were considered eligible. Performance of en bloc versus piecemeal resection was at the discretion of the endoscopist. Of 570 included lesions, 259 were removed by en bloc EMR (e-EMR) and the remainder were removed piecemeal (p-EMR). The risk of intraprocedural or delayed bleeding was comparable between arms, but there was significantly higher deep muscle injury (3.5% vs 1%) with e-EMR. In the e-EMR group, 18 lesions were considered high risk for invasive cancer, 9 had cancer, and 5 had superficial SMI and were considered cured. 

Overall, surgery was performed in 5.8% of patients in the e-EMR group and 3.7% in the p-EMR group. Recurrence at first follow-up was lower with e-EMR (2% vs 5.7%), but at the second follow-up, there was no significant difference between e-EMR and p-EMR (1.4% vs 2.4%). Four patients in the e-EMR group with residual polyp at first follow-up all had negative histologic margins at index EMR.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

Douglas K. Rex, MD, FASGE

CITATION(S)

Tate DJ, Sidhu M, Bar-Yishay I, et al. Impact of en bloc resection on long-term outcomes after endoscopic mucosal resection: a matched cohort study. Gastrointest Endosc 2019 Dec 27. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2019.12.025)