Recurrence rate after piecemeal endoscopic mucosal resection of <20 mm non-pedunculated colorectal lesions: should we worry about the risk?

Abstract

Introduction

There is scarce data focused on recurrence neoplasia rate (RR) after piecemeal endoscopic mucosal resection (pEMR) of 10–19 mm non-pedunculated colorectal lesions (NPL). We aimed to analyze the RR after pEMR of 10–19 mm NPL, identify risk factors for its development and compare it with RR after pEMR of ≥ 20 mm NPL.

Methods

Retrospective cohort-study including all ≥10 mm NPL resected by pEMR in our center between 2018–2022 with an early repeat colonoscopy (ERC). RR was defined as recurrence neoplasia identified in the ERC EMR scar with virtual chromoendoscopy or histological confirmation.

Results

A total of 444 NPL were assessed, 124 (27.9%) with 10–19 mm. In the ERC, performed a median of 6 months after pEMR, RR was significantly lower for 10–19 mm NPL compared to ≥ 20 mm NPL (13/124 vs 68/320, p = 0.005). In subgroup analysis, RR after pEMR of 15–19 mm NPL was significantly higher compared to 10–14 mm NPL (13/98 vs 0, p = 0.041) but not significantly different compared to ≥ 20 mm NPL (13/98 vs 68/320, p = 0.073). In multivariable analysis, size of NPL (HR 1.501, 95% CI 1.012–2.227, p = 0.044) was the only independent risk factor identified for RR for 10–19 mm NPL.

Conclusion

Although the early RR after pEMR of 10–19 mm NPL is significantly lower compared to ≥ 20 mm NPL, it is non-negligible (10.5%) and appears to be the highest among 15–19 mm NPL. The size of the lesion was the only independent risk factor for RR. Our findings should be accounted in the selection of the most appropriate post-polypectomy endoscopic surveillance.

Keywords:

• Piecemeal resection
• endoscopic mucosal resection
• recurrence rate
• colorectal polyps

Authors’ contributions

Tiago Lima Capela was involved in the design of the study; collection, statistical analysis and interpretation of the data; drafting of the article and in the final approval of the article. Ana Isabel Ferreira, Vítor Macedo Silva, Tiago Cúrdia Gonçalves, Francisca Dias de Castro and José Cotter were involved in the conception of the study and final approval of the article.

Ethics statement

Ethical approval was waived by the ‘Senhora da Oliveira Hospital’s Ethics Committee’ in view of the retrospective nature of the study. All methods were carried out in accordance with relevant guidelines and regulations including in accordance with the World Medical Association Declaration of Helsinki and were approved by the ‘Senhora da Oliveira Hospital’s Ethics Committee’.

Disclosure statement

The authors declare that they have no competing interests.

Data availability statement

All data generated or analyzed during this study are included in this article. Further enquiries can be directed to the corresponding author.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.