Virginia Tech Carilion School of Medicine westlake, OH
Mohamad Mouchli, MD1, Shravani R. Reddy, MD2, Christopher Walsh, MD3, Adil S. Mir, MD2, Lindsey A. Bierle, DO2, Vikas Chitnavis, MD1, Mohammad Shakhatreh, MD1, Paul Yeaton, MD3; 1Virginia Tech Carilion School of Medicine, Roanoke, VA; 2Carilion Clinic, Roanoke, VA; 3Virginia Tech Carilion, Roanoke, VA
Introduction: The efficacy of Endoscopic mucosal resection (EMR) on large colon polyps could be addressed by assessing the recurrence rate, complication rates, and the number of procedures needed to eradicate the residual tissue. It was reported that about 60% of the physicians in the United States believed that their Gastroenterology fellowship poorly prepared them for resecting large polyps.
Aims: Compare EMR efficacy and complication rates between skilled general gastroenterologists who perform high volume of EMR ( >20 years of experience) and advanced endoscopists who completed advanced endoscopy fellowship. Methods: We identified 140 patients with documented large colonic polyps treated by 4 providers using EMR technique at Carilion Clinic between 01/01/2014-12/31/2017, with follow-up through 10-2018. Information on demographics, clinical and pathological features of high-risk polyps (i.e., size, histology, site, and degree of dysplasia), timing of surveillance endoscopies, tools used during resection (i.e., endoclips, number of endoclips deployed, Argon plasma coagulation), and skills of performing endoscopist’s (i.e., completion of advanced endoscopy fellowship, withdrawal time) were extracted. The cumulative risks of polyp recurrence after first resection using EMR technique were estimated using Kaplan-Meier curves. Results: One hundred and forty patients identified (Mean age, 64.1±11.2 yrs; 47.1% males). Fifty-five polyps (39.3%) were removed by 2 skilled gastroenterologists (group 1 and group 2) and 85 (60.7%) were removed by advanced endoscopists (group 3 and group 4). Most of the polyps resected were located in the right colon (63.6%) and roughly half of the polyps were removed in piecemeal fashion. At follow-up endoscopy, groups 3 and 4 had lower polyp recurrence rates. When we compared the groups, the advanced endoscopy group used piecemeal resection, non-lifting EMR, and fellow assistance more frequently. The other groups used endoclips to close small defects post-polypectomy more frequently. The use of endoclips and argon plasma coagulation, withdrawal time, and complication rates varied between the groups. The median recurrence after polypectomy was significantly different between the groups (0.88 and 1.03 yrs for groups 1 and 2 vs. 3.99 yrs for group 4, p=0.03) (figure 1). Discussion: There is a need for additional EMR training since polyp recurrence was significantly different between the groups despite high rates of piecemeal resection in the advanced endoscopy groups.
Table 1. Clinical and demographic characteristics of patients with large polyps removed by general gastroenterologists and advanced endoscopists
Figure 1. Polyp recurrence at polypectomy site. Kaplan-Meier Curves for polyp recurrence among all patients who underwent EMR by general and advanced endoscopists indicates that the median recurrence after polypectomy was shorter for polyps removed by general gastroenterologists.
Disclosures: Mohamad Mouchli indicated no relevant financial relationships. Shravani Reddy indicated no relevant financial relationships. Christopher Walsh indicated no relevant financial relationships. Adil Mir indicated no relevant financial relationships. Lindsey Bierle indicated no relevant financial relationships. Vikas Chitnavis indicated no relevant financial relationships. Mohammad Shakhatreh indicated no relevant financial relationships. Paul Yeaton indicated no relevant financial relationships.