Outcomes of Deep Mural Injury After Endoscopic Resection: An International Cohort of 3717 Large Non-Pedunculated Colorectal Polyps

Iddo Bar-Yishay; Neal Shahidi; Sunil Gupta; Sergei Vosko; W Arnout van Hattem; Scott Schoeman; Mayenaaz Sidhu; David J Tate; Luke F Hourigan; Rajvinder Singh; Alan Moss; Spiro C Raftopoulos; Gregor Brown; Simon Zanati; Steven J Heitman; Eric Y T Lee; Nicholas Burgess; Stephen J Williams; Karen Byth; Michael J Bourke

doi:10.1016/j.cgh.2021.01.007

Outcomes of Deep Mural Injury After Endoscopic Resection: An International Cohort of 3717 Large Non-Pedunculated Colorectal Polyps

Clin Gastroenterol Hepatol. 2022 Feb;20(2):e139-e147. doi: 10.1016/j.cgh.2021.01.007. Epub 2021 Jan 8.

Authors

Iddo Bar-Yishay¹, Neal Shahidi², Sunil Gupta³, Sergei Vosko¹, W Arnout van Hattem¹, Scott Schoeman¹, Mayenaaz Sidhu³, David J Tate⁴, Luke F Hourigan⁵, Rajvinder Singh⁶, Alan Moss⁷, Spiro C Raftopoulos⁸, Gregor Brown⁹, Simon Zanati¹⁰, Steven J Heitman¹¹, Eric Y T Lee³, Nicholas Burgess³, Stephen J Williams³, Karen Byth¹², Michael J Bourke¹³

Affiliations

¹ Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, Australia.
² Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, Australia; Westmead Clinical School, University of Sydney, Sydney, Australia; University of British Columbia, Department of Medicine, Vancouver, Canada.
³ Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, Australia; Westmead Clinical School, University of Sydney, Sydney, Australia.
⁴ Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, Australia; University Hospital of Ghent, Ghent, Belgium.
⁵ Princess Alexandra Hospital, Department of Gastroenterology and Hepatology, Brisbane, Australia; The University of Queensland and Greenslopes Private Hospital, Gallipoli Medical Research Institute, School of Medicine, Brisbane, Australia.
⁶ Lyell McEwan Hospital, Department of Gastroenterology and Hepatology, Adelaide, Australia.
⁷ Western Health, Department of Endoscopic Services, Melbourne, Australia.
⁸ Sir Charles Gairdner Hospital, Department of Gastroenterology and Hepatology, Perth, Australia.
⁹ The Epworth Hospital, Department of Gastroenterology, Melbourne, Australia; The Alfred Hospital, Department of Gastroenterology and Hepatology, Melbourne, Australia.
¹⁰ Western Health, Department of Endoscopic Services, Melbourne, Australia; The Alfred Hospital, Department of Gastroenterology and Hepatology, Melbourne, Australia.
¹¹ University of Calgary, Cumming School of Medicine, Department of Medicine, Calgary, Canada.
¹² University of Sydney, National Health and Medical Research Council Clinical Trials Centre, Sydney, Australia; Westmead Hospital, Western Sydney Local Health District Research and Education Network, Sydney, Australia.
¹³ Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, Australia; Westmead Clinical School, University of Sydney, Sydney, Australia. Electronic address: [email protected].

PMID: 33422686
DOI: 10.1016/j.cgh.2021.01.007

Abstract

Background & aims: Although perforation is the most feared adverse event associated with endoscopic mucosal resection (EMR), limited data exists concerning its management. Therefore, we sought to evaluate the short- and long-term outcomes of intra-procedural deep mural injury (DMI) in an international multi-center observational cohort of large (≥20 mm) non-pedunculated colorectal polyps (LNPCPs).

Methods: Consecutive patients who underwent EMR for a LNPCP ≥20 mm were evaluated. Significant DMI (S-DMI) was defined as Sydney DMI Classification type III (muscularis propria injury, target sign) or type IV/V (perforation without or with contamination, respectively). The primary outcome was successful S-DMI defect closure. Secondary outcomes included technical success (removal of all visible polypoid tissue during index EMR), surgical referral and recurrence at first surveillance colonscopy (SC1).

Results: Between July 2008 to May 2020, 3717 LNPCPs underwent EMR. Median lesion size was 35mm (interquartile range (IQR) 25 to 45mm). Significant DMI was identified in 101 cases (2.7%), with successful defect closure in 98 (97.0%) using a median of 4 through-the-scope clips (TTSCs; IQR 3 to 6 TTSCs). Three (3.0%) patients underwent S-DMI-related urgent surgery. Technical success was achieved in 94 (93.1%) patients, with 46 (45.5%) admitted to hospital (median duration 1 day; IQR 1 to 2 days). Comparing LNPCPs with and without S-DMI, no differences in technical success (94 (93.1%) vs 3316 (91.7%); P = .62) or SC1 recurrence (12 (20.0%) vs 363 (13.6%); P = .15) were identified.

Conclusions: Significant DMI is readily managed endoscopically and does not appear to affect technical success or recurrence.

Keywords: Adverse Event; Colonoscopy; Complication; Endoscopy; Perforation.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cohort Studies
Colonic Polyps* / etiology
Colonic Polyps* / surgery
Colonoscopy / adverse effects
Colorectal Neoplasms* / etiology
Endoscopic Mucosal Resection* / adverse effects
Humans