Skip to main content
Log in

Predictive factors of local recurrence after endoscopic piecemeal mucosal resection

  • Original Article—Alimentary Tract
  • Published:
Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

Endoscopic piecemeal mucosal resection (EPMR) is a widely accepted treatment for colorectal tumefaction. However, as it is associated with a significant recurrence rate, the technique remains controversial. The purpose of our study was to evaluate the risk factors for the local recurrence of colorectal neoplasms after EPMR.

Methods

The study population of our retrospective evaluation comprised 222 patients who had undergone EPMR from January 2002 to July 2007 and who had had at least 1 surveillance colonoscopy 3–6 months after the initial treatment.

Results

Local recurrence was detected in 42 patients (19%) between 6 and 15 months after EPMR. Our multivariate analysis revealed that the resection of 5 or more neoplasm specimens, compared with fewer than 5, was 3 times more likely to result in local recurrence (P = 0.005). No statistically significant correlation of local recurrence with lesion size, location, macroscopic type, or histology was detected.

Conclusion

The removal of 5 or more neoplasm specimens is an independent risk factor for local recurrence after EPMR. Careful colonoscopic surveillance should be performed after multiple piecemeal resection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

Explore related subjects

Discover the latest articles and news from researchers in related subjects, suggested using machine learning.

References

  1. Saito Y, Fukuzawa M, Matsuda T, Fukunaga S, Sakamoto T, Uraoka T, et al. Clinical outcome of endoscopic submucosal dissection versus endoscopic mucosal resection of large colorectal tumors as determined by curative resection. Surg Endosc. 2010;24(2):343–52.

    Article  PubMed  Google Scholar 

  2. Saito Y, Uraoka T, Yamaguchi Y, Hotta K, Sakamoto N, Ikematsu H, et al. A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video). Gastrointest Endosc. 2010;72(6):1217–25.

    Article  PubMed  Google Scholar 

  3. Tanaka S, Tamegai Y, Tsuda S, Saito Y, Yahagi N, Yamano HO. Multicenter questionnaire survey on the current situation of colorectal endoscopic submucosal dissection in Japan. Dig Endosc. 2010;22(Suppl 1):S2–8.

    Article  PubMed  Google Scholar 

  4. Ahmad NA, Kochman ML, Long WB, Furth EE, Ginsberg GG. Efficacy, safety, and clinical outcomes of endoscopic mucosal resection: a study of 101 cases. Gastrointest Endosc. 2002;55(3):390–6.

    Article  PubMed  Google Scholar 

  5. Hurlstone DP, Sanders DS, Cross SS, Adam I, Shorthouse AJ, Brown S, et al. Colonoscopic resection of lateral spreading tumours: a prospective analysis of endoscopic mucosal resection. Gut. 2004;53(9):1334–9.

    Article  PubMed  CAS  Google Scholar 

  6. Kiesslich R, Neurath MF. Endoscopic mucosal resection: an evolving therapeutic strategy for non-polypoid colorectal neoplasia. Gut. 2004;53(9):1222–4.

    Article  PubMed  CAS  Google Scholar 

  7. Walsh RM, Ackroyd FW, Shellito PC. Endoscopic resection of large sessile colorectal polyps. Gastrointest Endosc. 1992;38(3):303–9.

    Article  PubMed  CAS  Google Scholar 

  8. Hotta K, Fujii T, Saito Y, Matsuda T. Local recurrence after endoscopic resection of colorectal tumors. Int J Colorectal Dis. 2009;24(2):225–30.

    Article  PubMed  Google Scholar 

  9. Tanaka S, Oka S, Chayama K. Colorectal endoscopic submucosal dissection: present status and future perspective, including its differentiation from endoscopic mucosal resection. J Gastroenterol. 2008;43(9):641–51.

    Article  PubMed  Google Scholar 

  10. Winawer SJ, Zauber AG, Fletcher RH, Stillman JS, O’Brien MJ, Levin B, et al.; US Multi-Society Task Force on Colorectal Cancer; American Cancer Society. Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society. Gastroenterology. 2006;130(6):1872–85.

    Google Scholar 

  11. Sakamoto T, Saito Y, Matsuda T, Fukunaga S, Nakajima T, Fujii T. Treatment strategy for recurrent or residual colorectal tumors after endoscopic resection. Surg Endosc. 2011;25(1):255–60.

    Article  PubMed  Google Scholar 

  12. The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon. Gastrointest Endosc. 2003;58(6 Suppl):S3–43.

  13. Luigiano C, Consolo P, Scaffidi MG, Strangio G, Giacobbe G, Alibrandi A, et al. Endoscopic mucosal resection for large and giant sessile and flat colorectal polyps: a single-center experience with long-term follow-up. Endoscopy. 2009;41(10):829–35.

    Article  PubMed  CAS  Google Scholar 

  14. Soetikno RM, Inoue H, Chang KJ. Endoscopic mucosal resection. Current concepts. Gastrointest Endosc Clin N Am. 2000;10(4):595–617, vi.

    Google Scholar 

  15. Tanaka S, Haruma K, Oka S, Takahashi R, Kunihiro M, Kitadai Y, et al. Clinicopathologic features and endoscopic treatment of superficially spreading colorectal neoplasms larger than 20 mm. Gastrointest Endosc. 2001;54(1):62–6.

    Article  PubMed  CAS  Google Scholar 

  16. Tamura S, Nakajo K, Yokoyama Y, Ohkawauchi K, Yamada T, Higashidani Y, et al. Evaluation of endoscopic mucosal resection for laterally spreading rectal tumors. Endoscopy. 2004;36(4):306–12.

    Article  PubMed  CAS  Google Scholar 

  17. Arebi N, Swain D, Suzuki N, Fraser C, Price A, Saunders BP. Endoscopic mucosal resection of 161 cases of large sessile or flat colorectal polyps. Scand J Gastroenterol. 2007;42(7):859–66.

    Article  PubMed  Google Scholar 

  18. Khashab M, Eid E, Rusche M, Rex DK. Incidence and predictors of “late” recurrence after endoscopic piecemeal resection of large sessile adenomas. Gastrointest Endosc. 2009;70(2):344–9.

    Article  PubMed  Google Scholar 

  19. Tanaka S, Oka S, Chayama K. Colorectal endoscopic submucosal dissection: present status and future perspective, including its differentiation from endoscopic resection. J Gastroenterol. 2008;43(9):641–51.

    Article  PubMed  Google Scholar 

  20. Pollard CW, Nivatvongs S, Rojanasakul A, Reiman HM, Dozois RR. The fate of patients following polypectomy alone for polyps containing invasive carcinoma. Dis Colon Rectum. 1992;35(10):933–7.

    Article  PubMed  CAS  Google Scholar 

  21. Ishikawa T, Ushio K, Miyagawa K, Nakashima H, Yokota T, Ono H, et al. Morphological features of local recurrent adenomas and carcinomas of the colon and rectum after polypectomy (in Japanese with English abstract). I Chou. 1993;28:511–22.

    Google Scholar 

  22. Matsuda K, Masaki T, Abo Y, Uchida H, Watanabe T, Muto T. Rapid growth of residual colonic tumor after incomplete mucosal resection. J Gastroenterol. 1999;34(2):260–3.

    Article  PubMed  CAS  Google Scholar 

  23. Tsunada S, Mannen K, Yamaguchi K, Aoki S, Uchihashi K, Toda S, et al. A case of advanced colonic cancer that developed from residual laterally spreading tumor treated by piecemeal endoscopic mucosal resection. Clin J Gastroenterol. 2008;1(1):18–22.

    Article  Google Scholar 

  24. Kunihiro M, Tanaka S, Haruma K, Kitadai Y, Yoshihara M, Sumii K, et al. Electrocautery snare resection stimulates cellular proliferation of residual colorectal tumor: an increasing gene expression related to tumor growth. Dis Colon Rectum. 2000;43(8):1107–15.

    Article  PubMed  CAS  Google Scholar 

  25. Kitajima K, Fujimori T, Fujii S, Takeda J, Ohkura Y, Kawamata H, et al. Correlations between lymph node metastasis and depth of submucosal invasion in submucosal invasive colorectal carcinoma: a Japanese collaborative study. J Gastroenterol. 2004;39(6):534–43.

    Article  PubMed  Google Scholar 

  26. Matsuda T, Fujii T, Saito Y, Nakajima T, Uraoka T, Kobayashi N, et al. Efficacy of the invasive/non-invasive pattern by magnifying chromoendoscopy to estimate the depth of invasion of early colorectal neoplasms. Am J Gastroenterol. 2008;103(11):2700–6.

    Article  PubMed  Google Scholar 

  27. Fu KI, Kato S, Sano Y, Onuma EK, Saito Y, Matsuda T, et al. Staging of early colorectal cancers: magnifying colonoscopy versus endoscopic ultrasonography for estimation of depth of invasion. Dig Dis Sci. 2008;53(7):1886–92.

    Article  PubMed  Google Scholar 

  28. Uraoka T, Saito Y, Matsuda T, Ikehara H, Gotoda T, Saito D, Fujii T. Endoscopic indications for endoscopic mucosal resection of laterally spreading tumours in the colorectum. Gut. 2006;55(11):1592–7.

    Article  PubMed  CAS  Google Scholar 

  29. Saito Y, Uraoka T, Matsuda T, Emura F, Ikehara H, Mashimo Y, et al. Endoscopic treatment of large superficial colorectal tumors: a case series of 200 endoscopic submucosal dissections (with video). Gastrointest Endosc. 2007;66(5):966–73.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Taku Sakamoto.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sakamoto, T., Matsuda, T., Otake, Y. et al. Predictive factors of local recurrence after endoscopic piecemeal mucosal resection. J Gastroenterol 47, 635–640 (2012). https://doi.org/10.1007/s00535-011-0524-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00535-011-0524-5

Keywords