Endoscopic mucosal resection outcomes and prediction of XXXX from advanced colonic mucosal neoplasia.

@entity1 @entity1127 @entity5 @entity652 @entity3503 @entity1586
BACKGROUND _ AIMS: Large sessile @entity1586 usually are managed surgically, with significant morbidity and potential mortality. There have been few prospective, intention-to-treat, multicenter studies of endoscopic mucosal resection (EMR). We investigated whether endoscopic criteria can predict invasive disease and direct the optimal treatment strategy. METHODS: The Australian Colonic Endoscopic (ACE) resection study group conducted a prospective, multicenter, observational study of all @entity1 referred for EMR of sessile @entity1127 that were 20 mm or greater in size (n=479, mean age, 68.5 y; mean lesion size, 35.6 mm). We analyzed data on lesion characteristics and procedural, clinical, and histologic outcomes. Multiple logistic regression analysis identified independent predictors of EMR efficacy and recurrence of @entity652 , based on findings from follow-up colonoscopy examinations. RESULTS: Risk factors for submucosal invasion were as follows: Paris classification 0-IIa+c morphology, nongranular surface, and Kudo pit pattern type V. The most commonly observed lesion (0-IIa granular) had a low rate of submucosal invasion (1.4%). EMR was effective at completely removing the polyp in a single session in 89.2% of @entity1 ; risk factors for lack of efficacy included a prior attempt at EMR (odds ratio [OR], 3.8; 95% confidence interval, 1.77-7.94; P=.001) and ileocecal valve involvement (OR, 3.4; 95% confidence interval, 1.20-9.52; P=.021). Independent predictors of recurrence after effective EMR were lesion size greater than 40 mm (OR, 4.37; 95% confidence interval, 2.43-7.88; P<.001) and use of @entity3503 plasma coagulation (OR, 3.51; 95% confidence interval, 1.69-7.27; P=.0017). There were no deaths from EMR; 83.7% of @entity1 avoided surgery. CONCLUSIONS: Large sessile @entity1586 can be managed safely and effectively by endoscopy. Endoscopic assessment identifies lesions at increased risk of containing @entity5 . The first EMR is an important determinant of @entity1 outcome-a previous attempt is a significant risk factor for lack of efficacy.
