UEGJournal Abstracts 2021 - 33

OP037
LESS IS MORE: THE IMPACT OF 2020 ESGE GUIDELINE ON POST
PIECEMEAL EMR SURVEILLANCE
OP038 WITHDRAWN
C. Nascimento1, B. Abreu1, J. Revés1
L.M. Roque Ramos1, L. Glória1
, B. Morão1
, A.O. Ferreira1
1Hospital Beatriz Ângelo, Department of Gastrenterology, Loures,
Portugal
Contact E-Mail Address: catarina.n.nascimento@gmail.com
Introduction: Endoscopic mucosal resection (EMR) has been shown to be
useful in the removal of large colorectal lesions, but recurrence is a limitation.
ESGE guidelines on post-polypectomy surveillance have changed in
2020 recommending short term surveillance only after piecemeal EMR of
polyps ≥ 20mm (instead of 10mm).
Aims & Methods: Our aim was to evaluate the impact of the new ESGE
guidelines for surveillance. Cohort retrospective study evaluating adenoma
recurrence after piecemeal EMR of lesions ≥ 10mm between 2018
and 2019 in a tertiary center. We excluded lesions with invasive neoplasia.
Patients were followed until the second follow up colonoscopy. Lesion
and procedure characteristics, adverse events and follow-up data were
collected.
Results: We included 215 patients (61.4% male; mean age 68.6 ± 0.91
years), submitted to EMR between 2018 and 2019. Mean lesion size was
21.2 ± 0.8 mm and 60.5% were located proximal to the hepatic flexure.
Morphologically, lesions were classified as Paris 0-IIa (65.6%), 0-Is (20.9%)
and 0-IIa+Is (13.5%). Based on narrow banding image (NBI), 83.5% of lesions
were NICE 2. Piecemeal resection was performed in 48.9% of the
cases (n=107). Most of the lesions were conventional adenomas (77.4%).
In 42.1% of the cases of piecemeal resections, the endoscopist used snare
tip soft coagulation with adenoma recurrence being lower in this group
(3.8% vs 10.2%, p = NS). The rate of complications was 6.5% (intra-procedural
bleeding, delayed bleeding, and deep mucosal injury) and similar
between en bloc and piecemeal resection. Prophylactic clipping was used
in 24.5% and there was no difference in the risk of recurrence (p=0.24).
Mean time to the first surveillance colonoscopy was 7.37+0.55 months and
for the second one was 16.5 + 0.96 months. The recurrence rate was 14.1%
and we found no association with lesion's dimension, location, high-grade
dysplasia or intra-procedural bleeding. The number needed to detect a
recurrence in lesions 10-19mm was 23 colonoscopies.
Conclusion: The adoption of the recent ESGE guideline may lead to a reduction
in the number of surveillance colonoscopies after piecemeal EMR
with the drawback of missing one recurrence for every 23 skipped colonoscopies.
References:
Hassan C, Antonelli G, Dumonceau JM, Regula J, Bretthauer
M, Chaussade S, Dekker E, Ferlitsch M, Gimeno-Garcia A, Jover R, Kalager
M, Pellisé M, Pox C, Ricciardiello L, Rutter M, Helsingen LM, Bleijenberg A,
Senore C, van Hooft JE, Dinis-Ribeiro M, Quintero E. Post-polypectomy
colonoscopy surveillance: European Society of Gastrointestinal Endoscopy
(ESGE) Guideline - Update 2020. Endoscopy. 2020 Aug;52(8):687-700.
doi: 10.1055/a-1185-3109. Epub 2020 Jun 22. PMID: 32572858.
Disclosure: Nothing to disclose.
,
OP039
IMPACT OF PROPHYLACTIC ENDOSCOPIC CLIP PLACEMENT ON
CLINICALLY SIGNIFICANT POST ENDOSCOPIC MUCOSAL RESECTION
BLEEDING IN THE RIGHT COLON - A RANDOMIZED CONTROLLED TRIAL
S. Gupta1,2, M. Sidhu1,2
S. Zahid1, A. Whitfield1,2
S.J Williams1,2
1
, N. Shahidi2,1,3
, K. Byth4,5
, S. Vosko1
, G. Brown6,7
, N.G Burgess1,2, M.J. Bourke2,1
Westmead Hospital, Sydney, Australia, Gastroenterology &
Hepatology, Sydney, Australia, 2
University of Sydney, Westmead
Clinical School, Sydney, Australia, 3University of British Columbia,
Department of Medicine, Vancouver, Canada, 4
Western Sydney Local Health District Research and Education
Network, Sydney, Australia, 5
Trials Centre, Sydney, Australia, 6
of Gastroenterology and Hepatology, Melbourne, Australia, 7
Westmead Hospital,
University of Sydney, NHMRC Clinical
Epworth Hospital, Department
The
Alfred Hospital, Department of Gastroenterology and Hepatology,
Melbourne, Australia
Contact E-Mail Address: sunil.gupta@live.com.au
Introduction: Endoscopic mucosal resection (EMR) is a cornerstone in the
management of large (≥ 20mm) non-pedunculated colorectal polyps (LNPCPs).
Clinically significant post-EMR bleeding (CSPEB) occurs in 7% overall
and is most frequently encountered in the right colon. The utility of prophylactic
clip closure has not been independently assessed in this setting.
Aims & Methods: We conducted a single-center randomized controlled trial
between February 2016 and December 2020. Eligible patients referred
for the EMR of LNPCPs in the right colon were randomised 1:1 into the clip
or control (no clip) group (NCT02196649).
The primary outcome was CSPEB, defined as hematochezia necessitating
emergency department presentation, hospitalization or re-intervention
within 14 days post-EMR. Secondary outcomes included CSPEB management,
adverse events and risk factors for CSPEB.
Herein we present the results of our interim analysis, following which the
study was closed due to demonstrable efficacy and emergence of corroborative
evidence in the literature.
Results: 231 LNPCPs in 231 patients were randomized (118 clip; 113 control).
By intention-to-treat analysis, CSPEB was lower in the clip group (4
[3.4%] vs. 12 [10.6%], P=0.031). The absolute risk reduction (ARR) was 7.2%
(95%CI 0.7-13.8%) and number needed to treat was 13.9. Clips were most
effective for LNPCPs 20-39mm (ARR 13.1%, 95%CI 4.6-21.6%, P=0.005) and
those within the caecum (ARR 14.7%, 95%CI 2.3-27.0%, P=0.046). There
was no difference in the time to CSPEB, adverse events or recurrence at
surveillance colonoscopy.
Conclusion: Prophylactic clip closure should be performed following the
EMR of LNPCPs ≥ 20mm in the right colon to reduce CSPEB risk.
Disclosure: This abstract was accepted for presentation at DDW 2021.
, O. McKay1,2
, E. Lee2,1
,
,
Vol. 9 | October 2021
33
Tuesday, October 5, 2021
Monday, October 4, 2021
Sunday, October 3, 2021
UEGJournal Abstracts 2021

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