P1297 - Predictors of Histologic-Confirmed Endoscopic Recurrence After Endoscopic Mucosal Resection (EMR) of Non-Pedunculated Polyps Larger Than 20 mm

Monday, October 25, 2021

10:30 AM – 4:15 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Scott N. Berger, MD

Baylor College of Medicine
Houston, TX, United States

Scott N. Berger, MD¹, Juan Gomez Cifuentes, MD¹, Kadon N. Caskey, BS¹, Andre N. Jove, BS¹, Allison Boden, MA², Clark Hair, MD¹, Robert J. Sealock, MD¹, Maria Velez, MD¹, Maria Ellionore Jarbrink-Sehgal, MD, PhD¹, Gyanprakash A. Ketwaroo, MD¹
¹Baylor College of Medicine, Houston, TX; ²University of Houston, Houston, TX

Introduction: Endoscopic recurrence after endoscopic mucosal resection (EMR) of non-pedunculated polyps larger than 20 mm have been reported anywhere from 9 to 31%. Polyp size, morphology and pathology, and piecemeal vs en-bloc resection have been suggested to be particular high-risk features for recurrence. Currently there exists no validated, accurate models to predict risk of polyp recurrence based on clinical variables from EMR. The aim of this study was to identify clinical predictors of histologic-confirmed recurrence after EMR of non-pedunculated polyps larger than 20 mm.

Methods: We conducted a retrospective cohort study of patients who underwent EMR of > 20mm non-pedunculated polyps at a county and Veteran’s Affairs hospital in Houston, Texas from 2012 to 2019. Patients who had two-staged procedures, non-neoplastic histology or evidence of invasive cancer were excluded from the analysis. Patients were designated as either having polyp recurrence (pathology-confirmed polyp) or non-recurrence surveillance colonoscopies. Demographic data, polyp, and resection characteristics between the two groups were compared using chi-squared and analysis of variance functions. Univariate and multivariate regressions of the clinical polyp features were performed with polyp recurrence as the dependent variable.

Results: A total of 523 non-pedunculated polyps were included from 468 unique patients. 328 lesions completed first surveillance colonoscopy and 85 (25.9%) lesions had polyp recurrence confirmed by pathology. 152 (46.3%) lesions completed second surveillance colonoscopy and 30 (19.7%) lesions had polyp recurrence on second surveillance. 24 patients had recurrence on both surveillance colonoscopies. The average time from index colonoscopy to first surveillance was 9.2 months and 16.5 months from first to second surveillance colonoscopy. For recurrent polyps, the index colonoscopy polyps were larger in size compared to non-recurrent index polyps: 32 +/- 14.0 mm vs 28 +/- 11.1 mm (p=0.032). A larger percentage of index polyps recurred when a piecemeal resection method was employed (p= 0.0028). After multivariable analysis, larger polyp size (>45 mm) and piecemeal resection were significantly associated with increased risk of recurrence (p = 0.048 and p= 0.019 respectively).

Discussion: Non-pedunculated polyps larger than 45 mm and resection by piecemeal EMR are predictors of histologic-confirmed polyp recurrence on surveillance colonoscopies.

Variable	Univariable		Multivariable
Variable	OR (95% CI)	P value	OR (95% CI)	P value
Polyp size >45mm	1.23 (1.04, 1.46)	0.016*	1.20 (1.00, 1.42)	0.048*
Piecemeal vs Enblock	1.18 (1.09, 1.27)	0.000023*	1.19 (1.03, 1.32)	0.019*
Tissue Ablation	1.09 (0.95, 1.24)	0.22	1.17 (0.92, 1.32)	0.23
Depressed Polyp	0.84 (0.64, 1.10)	0.22	0.81 (0.61, 1.06)	0.12
Intraprocedural Bleeding	0.99 (0.91, 1.09)	0.90	1.12 (0.84, 1.10)	0.56
TVA vs TA	1.02 (0.95, 1.10)	0.53	1.09 (0.93, 1.16)	0.53
High Grade Dysplasia	1.04 (0.95, 1.13)	0.39	1.04 (0.74, 1.05)	0.33
Positive Resection Margin	1.11 (0.97, 1.26)	0.12	1.17 (0.97, 1.40)	0.11

*< 0.05 significance

TVA= Tubulovillous adenoma; TA= Tubular adenoma

Table: Univariable and multivariable logistic regression analysis assessing odds of recurrence

Disclosures:

Scott Berger indicated no relevant financial relationships.

Juan Gomez Cifuentes indicated no relevant financial relationships.

Kadon Caskey indicated no relevant financial relationships.

Andre Jove indicated no relevant financial relationships.

Allison Boden indicated no relevant financial relationships.

Clark Hair indicated no relevant financial relationships.

Robert Sealock indicated no relevant financial relationships.

Maria Velez indicated no relevant financial relationships.

Maria Ellionore Jarbrink-Sehgal indicated no relevant financial relationships.

Gyanprakash Ketwaroo indicated no relevant financial relationships.

Scott N. Berger, MD¹, Juan Gomez Cifuentes, MD¹, Kadon N. Caskey, BS¹, Andre N. Jove, BS¹, Allison Boden, MA², Clark Hair, MD¹, Robert J. Sealock, MD¹, Maria Velez, MD¹, Maria Ellionore Jarbrink-Sehgal, MD, PhD¹, Gyanprakash A. Ketwaroo, MD¹. P1297 - Predictors of Histologic-Confirmed Endoscopic Recurrence After Endoscopic Mucosal Resection (EMR) of Non-Pedunculated Polyps Larger Than 20 mm, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.