Copyright
©The Author(s) 2023.
World J Gastrointest Endosc. Jun 16, 2023; 15(6): 458-468
Published online Jun 16, 2023. doi: 10.4253/wjge.v15.i6.458
Published online Jun 16, 2023. doi: 10.4253/wjge.v15.i6.458
Table 1 Patient characteristics by intervention, n (%)
| N = 376 | ESD (n = 122) | Knife-assisted endoscopic resection (n = 44) | EMR (n = 216) | P value |
| Mean age (mean ± SD) | 66.9 (11.8) | 64.5 (11.8) | 66 (9.7) | 0.452 |
| Male (%) | 78 (63.9) | 23 (52.3) | 130 (60.2) | 0.395 |
| Race/Ethnicity | 0.113 | |||
| White | 78 (63.9) | 28 (63.6) | 144 (66.7) | |
| Asian | 19 (15.6) | 6 (13.6) | 12 (5.6) | |
| African American | 4 (3.3) | 1 (2.3) | 11 (5.1) | |
| Latino | 14 (11.5) | 6 (13.6) | 25 (11.6) | |
| Other | 7 (5.7) | 3 (6.8) | 24 (11.1) | |
| Sedation | < 0.001 | |||
| General anesthesia | 11 (9.0) | 2 (4.5) | 7 (3.2) | |
| Monitored anesthesia care | 93 (76.2) | 29 (65.9) | 117 (54.2) | |
| Moderate sedation | 17 (13.9) | 13 (29.5) | 82 (38.0) | |
| None | 1 (0.8) | 0 (0.0) | 10 (4.6) | |
| Adequate bowel preparation | 121 (99.2) | 41 (93.2) | 210 (97.2) | 0.100 |
Table 2 Characteristics of polyp with follow-up, by intervention, n (%)
| N = 287 | ESD (n = 77) | Knife-assisted endoscopic resection (n = 32) | EMR (n = 178) | P value |
| Size of polyp, mm (mean ± SD) | 37.2 (19.7) | 32.7 (8.7) | 31.4 (11.5) | 0.010 |
| En bloc | 69 (89.7) | 8 (25.0) | 27 (15.2) | < 0.001 |
| Location of polyp | < 0.001 | |||
| Cecum | 10 (13.0) | 7 (21.9) | 47 (26.4) | |
| Ascending | 13 (16.9) | 12 (37.5) | 63 (35.4) | |
| Transverse | 8 (10.4) | 6 (18.8) | 45 (25.3) | |
| Descending | 2 (2.6) | 4 (12.5) | 12 (6.7) | |
| Sigmoid | 10 (13.0) | 1 (3.1) | 5 (2.8) | |
| Rectum | 34 (44.2) | 2 (6.3) | 6 (3.4) | |
| Paris classification | < 0.001 | |||
| Is | 57 (74.0) | 18 (56.3) | 64 (36.0) | |
| IIa | 16 (20.8) | 9 (28.1) | 102 (57.3) | |
| IIb | 0 (0.0) | 1 (3.1) | 2 (1.1) | |
| IIa+c | 2 (2.6) | 1 (3.1) | 2 (1.1) | |
| IIc | 0 (0.0) | 1 (3.1) | 0 (0.0) | |
| Isp | 2 (2.6) | 2 (6.3) | 8 (4.5) | |
| Pathology | < 0.001 | |||
| Non-neoplastic | 0 (0.0) | 1 (3.1) | 10 (5.6) | |
| Neoplastic, no high-grade dysplasia | 50 (64.9) | 25 (78.1) | 152 (85.4) | |
| High-grade dysplasia | 17 (22.1) | 6 (18.8) | 12 (6.7) | |
| Cancer | 10 (13.0) | 0 (0.0) | 4 (2.2) | |
| First follow-up, days (mean ± SD) | 456.8 (326.1) | 365.0 (230.2) | 516.2 (377.7) | 0.061 |
| Recurrence | 1 (1.3) | 0 (0.0) | 23 (12.9) | 0.0017 |
| Complete resection | < 0.001 | |||
| R0 | 57 (74.0) | 6 (18.8) | 8 (4.5) | |
| R1 | 18 (23.4) | 26 (81.3) | 156 (87.6) | |
| Rx | 2 (2.6) | 0 (0.0) | 14 (7.9) |
Table 3 Comparison of recurrence with no recurrence
| Recurrence, n (%) | No recurrence, n (%) | P value | |
| Size of polyp, mm (mean ± SD) | 37.4 (17.1) | 32.7 (13.8) | 0.202 |
| Procedure | 0.002 | ||
| ESD | 1/24 (4.2) | 76/263 (28.9) | |
| Knife-assisted endoscopic removal | 0/24 (0.0) | 32/263 (12.2) | |
| EMR | 23/24 (95.8) | 155/263 (58.9) | |
| En bloc resection | 0.003 | ||
| En bloc | 2/24 (8.3) | 102/263 (38.8) | |
| Non en bloc | 22/24 (91.7) | 161/263 (61.2) | |
| Circumferential incision | 0.001 | ||
| Yes | 1/99 (1.0) | 98/99 (99.0) | |
| No | 23/188 (12.2) | 165/188 (87.8) | |
| Prior resection | 0.154 | ||
| Prior attempt | 3/24 (12.5) (17.6) | 14/263 (5.3) | |
| No prior attempt | 21/24 (87.5) | 249/263 (94.7) | |
| Pathology | 0.691 | ||
| Non-neoplastic | 0/24 (0.0) | 11/263 (4.2) | |
| Neoplastic, no high-grade dysplasia | 19/24 (79.2) | 208/263 (79.1) | |
| High-grade dysplasia | 4/24 (16.7) | 31/263 (11.8) | |
| Cancer | 1/24 (4.2) | 13/263 (4.9) | |
| First follow-up, days (mean ± SD) | 498.0 (406.9) | 482.0 (348.7) | 0.854 |
| Complete resection | 0.041 | ||
| R0 | 1/24 (4.2) | 70/263 (26.6) | |
| R1 | 22/24 (91.7) | 178/263 (67.7) | |
| Rx | 1/24 (4.2) | 15/263 (5.7) |
Table 4 Patient complications, n (%)
| N = 376 | ESD (n = 122) | Knife-assisted endoscopic resection (n = 44) | EMR (n = 216) |
| Complication | 8 (6.6) | 3 (6.8) | 14 (6.5) |
| Bleeding without intervention | 3 (2.5)1 | 1 (2.3)1 | 5 (2.3) |
| Bleeding with intervention | 3 (2.5) | 1 (2.3) | 1 (0.5) |
| SBO/partial SBO | 0 (0.0) | 0 (0.0) | 2 (0.9) |
| Bowel perforation | 2 (1.6) | 1 (2.3) | 0 (0.0) |
| Abdominal pain | 1 (0.8)1 | 1 (2.3)1 | 3 (1.4) |
| Unrelated complication | 0 (0.0) | 0 (0.0) | 3 (1.4) |
Table 5 Univariate Cox regression evaluating predictors of recurrence, including endoscopic submucosal dissection versus endoscopic mucosal resection
| Covariates | Unadjusted hazard ratio (95%CI) | P value |
| Treatment type | 0.041 | |
| EMR, pure | Reference | |
| ESD, pure | 0.12 (0.02-0.92) | |
| Age, per year | 1.04 (0.99-1.08) | 0.109 |
| Sex | 0.898 | |
| Female | Reference | |
| Male | 1.06 (0.46-2.40) | |
| Race | 0.139 | |
| White | Reference | |
| Non-White | 1.85 (0.82-4.19) | |
| Polyp location | 0.376 | |
| Non-rectum | Reference | |
| Rectum | 0.52 (0.12-2.22) | |
| Prior resection attempt | 2.65 (0.76-9.29) | 0.127 |
| Polyp size, by mm | 1.03 (1.01-1.05) | 0.001 |
| Presence of circumferential incision | 0.12 (0.02-0.92) | 0.041 |
| En bloc resection | 0.15 (0.03-0.63) | 0.010 |
| JNET classification | ||
| Type 1 | Reference | |
| Type 2A | 3.07 (0.41-22.92) | 0.273 |
| Type 2B or 3 | 4.57 (0.41-50.74) | 0.216 |
| R0 resection | 0.13 (0.02-0.93) | 0.042 |
Table 6 Multivariate Cox regression evaluating predictors of recurrence
| Covariates | Adjusted hazard ratio (95%CI) | P value |
| Treatment type | 0.014 | |
| EMR, pure | Reference | |
| ESD, pure | 0.06 (0.01-0.57) | |
| Polyp size, by mm | 1.05 (1.02-1.07) | < 0.001 |
- Citation: Wei MT, Zhou MJ, Li AA, Ofosu A, Hwang JH, Friedland S. Multicenter evaluation of recurrence in endoscopic submucosal dissection and endoscopic mucosal resection in the colon: A Western perspective. World J Gastrointest Endosc 2023; 15(6): 458-468
- URL: https://www.wjgnet.com/1948-5190/full/v15/i6/458.htm
- DOI: https://dx.doi.org/10.4253/wjge.v15.i6.458