Long-term Adenoma Recurrence and Development of Colorectal Cancer Following Piecemeal Endoscopic Mucosal Resection (EMR) in Large Non-Pedunculated Colonic Polyps≥4cm (LNPCPs)

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Aims The purpose of the study is to assess the adenoma recurrence, as well as the the development of colorectal cancer after piecemeal EMR in LNPCPs≥4cm. To the best of our knowledge, this is the first study on this issue in Greece. Methods This is a prospective study of a reference center from 2009 to 2020. Inclusion criteria were the presence of an adenomatous polyp≥4cm in size, 0-IIa+Is according to Paris classification, SMSA score IV and complete endoscopic removal by EMR method. Results 142 patients were included in the study (57.7% men, median age 67 years). The median polyp size was 5 cm. (range 4-10cm.) with localization of 56.3% in the left and 43.7% in the right colon. Early recurrence/residual tissue was found in 43 polyps (30.3%), while late recurrence in 12 (8.5%). The intervals 2009-2016 & 2017-2020 recurrence rates were 9.46% and 7.35%, respectively. In 6 patients, further treatment was decided with colectomy (5 patients) and full-thickness endoscopic resection (1 patient). The mean time to appearance of residual/early recurrent tissue was 2.6 months (range 2.13-3.07 months), while the corresponding time to late recurrence was 22.26 months (range 7.7-44 months). The mean endoscopic follow-up time was 35.3 months (range 7.7-62.9 months) with a mean number of colonoscopies 3.08/patient, excluding the reference colonoscopy. No patient developed colorectal cancer with a mean follow-up of 74.06 months (range 7.7-140.43 months). Conclusions Data from this historical cohort study show that the EMR of LNPCPs≥4cm. is a method of first choice with low adenoma recurrence rate and zero incidence rate of colorectal cancer. Publication History Article published online: 15 April 2024 © 2024. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

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