Abstract
Background and aims: Piecemeal endoscopic mucosal resection (pEMR) allows resection of larger non-invasive colorectal lesions. Adenoma recurrence is an important limitation and occurs in ≤20%. The present study aimed to validate the Sydney EMR recurrence tool (SERT) score as a predictor of both endoscopic and histologic recurrence and evaluate interobserver agreement in adenoma recurrence based on endoscopic scar assessment, among nonexperts in EMR.
Methods: Retrospective cohort and cross-sectional study, in which all patients submitted to pEMR in a tertiary care center in Portugal, between 2012 and 2018 were included. SERT-score was calculated for all lesions and compared with the SMSA (size, morphology, site, access) score already validated as a predictor of adenoma recurrence. Image based offline analysis was performed to evaluate adenoma recurrence prediction and assess the interobserver agreement within a heterogeneous group of participants, mostly composed by nonexperts in EMR.
Results: There was a moderate positive correlation between the SERT and SMSA scores (p <.001; r = 0.61). SERT-score was significantly associated with endoscopic recurrence (p =.005) and histologic recurrence (p = .015). Endoscopic prediction of recurrence had high coefficient of agreement (k-0.806; p < .001).
Conclusion: Histologic recurrence after pEMR can be predicted by SERT score and optical diagnosis of recurrent adenoma has high interobserver agreement between nonexperts in EMR.
Acknowledgements
Silva JC wrote the manuscript. Silva JC, Pinho R and Fernandes C designed the study; Pinho R and Carvalho J revised the paper critically for important intellectual content. Proença L, Rodrigues A, Ponte A, Rodrigues J, Silva AP, Fernandes S, Leite S, Freitas T, Sousa M, Gomes AC and Afecto E participated in the image-based offline assessment. All authors approved the final version of the manuscript.
Author contributions
Silva JC, Rolando P and Fernandes C designed the study, performed the research, analysed the data and wrote the paper. Proença L, Rodrigues A, Ponte A, Rodrigues J, Silva AP, Sousa M, Gomes AC and Afecto E performed the research and analysed data. Carvalho J revised the paper critically for important intellectual content.
Disclosure statement
The authors report no conflict of interest.