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Original Article

Long-term follow-up after EMR of large colorectal lesions: metachronous lesions, predictors and surveillance timing

, , , , ORCID Icon &
Pages 1487-1493 | Received 28 Apr 2019, Accepted 12 Nov 2019, Published online: 10 Dec 2019
 

Abstract

Background: Endoscopic mucosal resection (EMR) is the first-line approach to large colorectal sessile lesions. These patients have been associated with high rates of metachronous lesions (ML), but long-term follow-up (LtFU) data are lacking. We aimed at evaluating the efficacy of an LtFU protocol and analyse the development and risk factors for ML.

Methods: A prospectively collected database was analysed. Seventy-six patients submitted to EMR of large colorectal sessile lesions between 2007 and 2013 complied with a specific endoscopic surveillance, consisting of two protocols – initial follow-up (iFU) and LtFU. iFU intended to inspect the mucosectomy scars twice (at 3–6 and 12 months) and remove synchronous lesions (SL). Protocol examinations of LtFU were carried out at the first- and fourth-year post-iFU, aiming to remove ML. Statistical analysis included variables related to patient, index lesion, SL and ML characteristics.

Results: Rates of ML were 39.5% and 20.4% at the first- and fourth-year of LtFU, and respectively 11.8% and 3.7% of them were advanced ML. All ML were endoscopically resectable. At univariate analysis, male gender (OR: 2.91; p=.029), the presence of SL (OR 3.86, p=.010) and advanced SL (OR 4.25, p=.006) were risk factors for ML. At multivariate analysis, male gender (p=.031) and advanced SL (p=.006) were significant predictors of ML development.

Conclusions: We confirmed the increased risk of ML in patients with large colorectal lesions. A significant number of advanced ML was removed at the first LtFU colonoscopy, probably it should be carried out earlier than currently recommended.

Disclosure statement

Drs. Dalila Costa, Mariana Brandão, Ana Braga, Rita Costa, Raquel Gonçalves and Carla Rolanda have no conflicts of interest or financial ties to disclose.

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