Related Experiment Video
Updated: Jul 4, 2025
ADSC-sheet Transplantation to Prevent Stricture after Extended Esophageal Endoscopic Submucosal Dissection
Published on: February 10, 2017
Incomplete mucosal layer excision during EMR: a potential source of recurrent adenoma (with video)
David J Tate1, Sergei Vosko2, Iddo Bar-Yishay2
1Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia; Medical School, University of Sydney, Westmead, New South Wales, Australia; Department of Gastroenterology and Hepatology, University Hospital of Ghent, Ghent, Belgium; Faculty of Health Sciences, University of Ghent, Ghent, Belgium.
Incomplete mucosal layer excision (IME) after endoscopic resection of large colorectal polyps may contain residual adenoma, posing a risk for recurrence. Careful evaluation and excision of IME in the post-endoscopic resection defect (PED) can prevent residual or recurrent adenoma (RRA).
Area of Science:
- Gastroenterology
- Endoscopic Surgery
- Colorectal Oncology
Background:
- Endoscopic mucosal resection (EMR) is limited by residual or recurrent adenoma (RRA) detection during surveillance.
- The pathogenesis of RRA remains unclear, though thermal ablation of the post-endoscopic resection defect (PED) margin shows promise in reducing RRA.
- Identifying specific features within the PED associated with RRA is crucial for improving EMR outcomes.
Purpose of the Study:
- To identify a specific feature within the post-endoscopic resection defect (PED) that is associated with residual or recurrent adenoma (RRA) after endoscopic mucosal resection (EMR).
Main Methods:
- Retrospective analysis of prospective procedural data from 508 large nonpedunculated colorectal polyp (LNPCP) EMRs.
- Systematic examination of the PED for incomplete mucosal layer excision (IME), defined by specific endoscopic features.
- Histopathologic review of excised IME areas to identify residual tissue and adenoma.
Main Results:
- Incomplete mucosal layer excision (IME) was identified in 2.0% of post-endoscopic resection defects (PEDs).
- Histopathology confirmed residual adenoma in 50% of IME specimens.
- No residual or recurrent adenoma (RRA) was detected during follow-up after re-excision of IME.
Conclusions:
- Incomplete mucosal layer excision (IME) within the post-endoscopic resection defect (PED) after endoscopic mucosal resection (EMR) is a novel finding.
- IME may harbor microscopic residual adenoma, representing a risk factor for residual or recurrent adenoma (RRA).
- Careful evaluation and excision of IME in the PED are recommended to prevent RRA during follow-up.
