Endoscopy 2019; 51(04): S191
DOI: 10.1055/s-0039-1681736
ESGE Days 2019 ePoster podium presentations
Saturday, April 6, 2019 14:00 – 14:30: Colon: resection 6 ePoster Podium 2
Georg Thieme Verlag KG Stuttgart · New York

SHOULD WE USE THE SMSA AND SERT SCORES TO PREDICT OUTCOMES IN COLONIC PIECEMEAL EMR?

F Taveira
1   Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
,
M Areia
1   Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
,
M João
1   Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
,
L Elvas
1   Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
,
S Alves
1   Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
,
D Brito
1   Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
,
S Saraiva
1   Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
,
AT Cadime
1   Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 

Aims:

Predicting outcomes after piecemeal endoscopic mucosal resection (pEMR) is a major concern with the development of scores such as SMSA, predicting the complexity of excision, or SERT predicting the negative risk for recurrence after pEMR. We intended to apply both scores to a pEMR cohort and understand if SMSA and SERT have clinical applicability in this setting.

Methods:

Single center, prospective cohort of pEMR of colon lesions ≥20 mm, since 2009, with retrospective application of SMSA and SERT scores. Evaluation of patients and lesions characteristics, risk factors for endoscopic recurrence and relation with score result with recurrence (SMSA = 4 in favor, SERT = 0 against). Statistical analysis included descriptive statistics, Qui2 test and multivariable regression.

Results:

Analyzed 302 lesions, in 296 patients, 58% men with median age of 70 years. Lesions had a median size of 30 mm (IQR 15), in the right colon in 51%. Paris classification Is in 51% and IIa in 24%; LST granular type in 86%. Median SMSA score was 12; SMSA = 4 in 46% (n = 138 lesions); SERT = 0 in 38% (115 lesions). Complications occurred in 7,3% (n = 23), mostly bleeding (n = 20).

Endoscopic recurrence of 18,5% (n = 56) at first surveillance and 7% (n = 17) late recurrence. In univariate analysis, SMSA = 4 (p < 0.001), high-grade dysplasia (p = 0.003) and size> 40 mm (p < 0.001) but not intraprocedural bleeding (p = 0.09) were significant factors for recurrence. Multivariable analysis confirmed SMSA = 4 as predictor of recurrence (OR 3.8; IC95% 1.8 – 7.9); In the other hand, SERT = 0 is a predictor for no recurrence (OR 0.3; IC95% 0.1 – 0.8). No relation was found between higher SMSA score and the occurrence of complications (OR 1,3; IC95% 0,5 – 3,2).

Conclusions:

SMSA and SERT scores have applicability in the management of follow-up after colonic pEMR. We recommend closer surveillance in SMSA = 4 lesions, while the first surveillance exam in SERT = 0 lesions might be delayed.