TBA (24W179)

Early recurrence is rare after cold snare resection for large sessile serrated lesions of the colon

Author(s)

Morrissey E, Bhuplan A, Cronin C, Aird J, Campion J, Lahiff C

Department(s)/Institutions

Gastrointestinal Unit, Mater Misericordiae University Hospital

Introduction

Sessile serrated lesions (SSL) are pre-cancerous lesions that require endoscopic resection. Cold snare piecemeal endoscopic mucosal resection (cspEMR) has been shown to be equally effective and potentially safer than traditional EMR. Lesions tend to be right sided. Early surveillance site check is recommended but represents a high resource burden and yields are felt to be low.

Aims/Background

To assess recurrence and complication rates for SSLs following cspEMR, and determine value of early site check examinations.

Method

Consecutive patients with large SSLs referred for endoscopic resection over a five year period, were captured on a prospectively-maintained database (MATER Registry). Where clinically appropriate, patients are offered site check examinations at 6 (SC1) and 18 months (SC2) post resection. We searched retrospectively for SSLs using validated search terms.

Results

SSLs were identified in 57 patients. The majority (65%) were female. Median age was 65 (range 33-89). All had conscious sedation. Median polyp size was 20mm (range 10-40). Polyps were located predominantly in the right colon (95%). Endoscopic diagnosis was correct in 88%. cspEMR was performed in 77%. The remainder were resected by hot snare methods. Median resection time was 26 minutes (range 5-67). Intra-procedural bleeding was encountered in six patients (10%) and managed endoscopically in all cases. The complication rate in the cold snare group was 6.8% compared to 21.4% in the hot snare group. Dysplasia was present in nine patients (16%). SC1 (n=40) was performed at a median interval of 191 days and 0 patients had endoscopic or histological recurrence. SC2 (n=15) was performed at median 784 days and 2 (3%) patients had histologically confirmed recurrence, managed endoscopically in all cases.

Conclusions

Piecemeal cold snare EMR for SSLs is safe and effective and is associated with very low rates of recurrence. Consideration should be given to a surveillance timeline that is specific to SSLs and may differ form that required for adenoma.