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Outcomes of Deep Mural Injury After Endoscopic Resection: An International Cohort of 3717 Large Non-Pedunculated
Iddo Bar-Yishay1, Neal Shahidi2, Sunil Gupta3
1Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, Australia.
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.
Insights
Deep mural injury (DMI) during endoscopic mucosal resection (EMR) for large colorectal polyps is manageable with endoscopic closure. This adverse event does not impact the success or recurrence rates of EMR procedures.
Area of Science:
- Gastroenterology
- Endoscopic Surgery
- Colorectal Surgery
Background:
- Perforation is a feared complication of endoscopic mucosal resection (EMR).
- Limited data exists on the management of intra-procedural deep mural injury (DMI).
- This study evaluates outcomes of DMI during EMR for large colorectal polyps.
Purpose of the Study:
- To assess short- and long-term outcomes of intra-procedural DMI during EMR.
- To evaluate the efficacy of endoscopic management for DMI.
- To determine if DMI affects technical success or recurrence rates.
Main Methods:
- International multi-center observational cohort study.
- Included patients undergoing EMR for large (≥20 mm) non-pedunculated colorectal polyps.
- Defined Significant DMI (S-DMI) and assessed defect closure, technical success, surgical referral, and recurrence.
Main Results:
- Significant DMI occurred in 2.7% of 3717 EMRs for large polyps.
- Successful endoscopic closure of S-DMI defects was achieved in 97.0% using through-the-scope clips.
- No significant differences in technical success or recurrence rates were observed between polyps with or without S-DMI.
Conclusions:
- Significant DMI is effectively managed endoscopically.
- Endoscopic management of DMI does not compromise EMR technical success.
- DMI does not appear to influence the recurrence rates of large colorectal polyps after EMR.
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