CC BY-NC-ND 4.0 · Endosc Int Open 2018; 06(02): E230-E241
DOI: 10.1055/s-0043-122070
Original article
Eigentümer und Copyright ©Georg Thieme Verlag KG 2018

Adenoma recurrence after endoscopic mucosal resection: propensity score analysis of old and new colonoscopes and Sydney recurrence tool implementation

Daniela Guerrero Vinsard
Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
Division of Internal Medicine, University of Connecticut Health Center, Farmington, Connecticut, United States
,
Pujan Kandel
Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
,
Lady Katherine Mejia Perez
Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
,
Russell L. Bingham
Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
,
Ryan J. Lennon
Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, United States
,
Timothy A. Woodward
Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
,
Victoria Gomez
Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
,
Massimo Raimondo
Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
,
Ernest P. Bouras
Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
,
Michael B. Wallace
Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
› Author Affiliations
Further Information

Publication History

submitted 14 June 2017

accepted after revision 25 October 2017

Publication Date:
07 February 2018 (online)

Abstract

Background and study aims Risk factors for colorectal adenoma recurrence after endoscopic mucosal resection (EMR) have been well documented. We assessed the efficacy of the newer 190 colonoscope versus the standard 180 colonoscope for complete resection of lateral spreading lesions.

Patients and methods A single-center, retrospective study of patients who underwent EMR with Olympus 180 or 190 colonoscopes from January 1, 2010 to September 30, 2016. We included patients with lesions ≥ 20 mm and surveillance colonoscopy (SC1) after index EMR. A propensity score approach with inverse probability weighting was used to control for potential confounders. A secondary aim was to identify risk factors for recurrence and assess the applicability of the Sydney EMR recurrence tool (SERT) by grading each lesion of our cohort and analyzing associations with recurrence.

Results Two hundred ninety-one lesions met inclusion criteria for the study. Odds ratio (OR) for recurrence with the 190 colonoscope was 1.06 (P = .85). Adenoma size (P = .02) and use of argon plasma coagulation (APC; P < .001) were risk factors for recurrence. Lesions with SERT scores > 0 had a higher recurrence risk during follow-up (32 % vs 21 %; OR 1.71; P = .05). Lesions with SERT scores = 0 reached a plateau for recurrence at 12 and 18 months in Kaplan-Meier curves.

Conclusions The use of 190 colonoscopes did not measurably affect adenoma recurrence at SC1. Recurrence was associated with adenoma size, complementary APC for resection, and SERT scores > 0. Lesions with SERT scores = 0 that remain negative for recurrence at 18 months may return to routine surveillance.