The size, morphology, site, and access score predicts critical outcomes of endoscopic mucosal resection in the colon

Mayenaaz Sidhu; David J. Tate; Lobke Desomer; Gregor Brown; Luke F. Hourigan; Eric Y. T. Lee; Alan Moss; Spiro Raftopoulos; Rajvinder Singh; Stephen J. Williams; Simon Zanati; Nicholas Burgess; Michael J. Bourke

doi:10.1055/s-0043-124081

Endoscopy, Table of Contents

Endoscopy 2018; 50(07): 684-692
DOI: 10.1055/s-0043-124081

Original article

The size, morphology, site, and access score predicts critical outcomes of endoscopic mucosal resection in the colon

Mayenaaz Sidhu^*

¹Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia

,

David J. Tate^*

¹Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia

²Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia

,

Lobke Desomer

¹Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia

,

Gregor Brown

³Department of Gastroenterology and Hepatology, The Alfred Hospital, Melbourne, Victoria, Australia

⁴Department of Gastroenterology and Hepatology, Epworth Hospital, Melbourne, Victoria, Australia

,

Luke F. Hourigan

⁵Department of Gastroenterology and Hepatology, Greenslopes Private Hospital, Brisbane, Queensland, Australia

⁶Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia

,

Eric Y. T. Lee

¹Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia

,

Alan Moss

⁷Department of Gastroenterology and Hepatology, Footscray Hospital, Melbourne, Victoria, Australia

⁸Department of Medicine, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia

,

Spiro Raftopoulos

⁹Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia

,

Rajvinder Singh

¹⁰Department of Gastroenterology and Hepatology, Lyell McEwan Hospital, Adelaide, South Australia, Australia

,

Stephen J. Williams

¹Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia

,

Simon Zanati

³Department of Gastroenterology and Hepatology, The Alfred Hospital, Melbourne, Victoria, Australia

⁷Department of Gastroenterology and Hepatology, Footscray Hospital, Melbourne, Victoria, Australia

,

Nicholas Burgess

¹Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia

,

Michael J. Bourke

¹Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia

²Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia

› Author Affiliations

Abstract

Background The SMSA (size, morphology, site, access) polyp scoring system is a method of stratifying the difficulty of polypectomy through assessment of four domains. The aim of this study was to evaluate the ability of SMSA to predict critical outcomes of endoscopic mucosal resection (EMR).

Methods We retrospectively applied SMSA to a prospectively collected multicenter database of large colonic laterally spreading lesions (LSLs) ≥ 20 mm referred for EMR. Standard inject-and-resect EMR procedures were performed. The primary end points were correlation of SMSA level with technical success, adverse events, and endoscopic recurrence.

Results 2675 lesions in 2675 patients (52.6 % male) underwent EMR. Failed single-session EMR occurred in 124 LSLs (4.6 %) and was predicted by the SMSA score (P < 0.001). Intraprocedural and clinically significant postendoscopic bleeding was significantly less common for SMSA 2 LSLs (odds ratio [OR] 0.36, P < 0.001 and OR 0.23, P < 0.01) and SMSA 3 LSLs (OR 0.41, P < 0.001 and OR 0.60, P = 0.05) compared with SMSA 4 lesions. Similarly, endoscopic recurrence at first surveillance was less likely among SMSA 2 (OR 0.19, P < 0.001) and SMSA 3 (OR 0.33, P < 0.001) lesions compared with SMSA 4 lesions. This also extended to second surveillance among SMSA 4 LSLs.

Conclusion SMSA is a simple, readily applicable, clinical score that identifies a subgroup of patients who are at increased risk of failed EMR, adverse events, and adenoma recurrence at surveillance colonoscopy. This information may be useful for improving informed consent, planning endoscopy lists, and developing quality control measures for practitioners of EMR, with potential implications for EMR benchmarking and training.

Full Text

References

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Supplementary Material

Supplementary material