Knowledge Check
In the study comparing cold endoscopic mucosal resection of medium to large colorectal adenomas versus sessile serrated lesions, what was the recurrence rate at 6-month follow-up for adenomas measuring ≥ 20 mm?
- 3%
- 4%
- 16%
- 1%
More on Cold EMR Efficacy in Adenomas and Sessile Serrated Lesions
Douglas K. Rex, MD, MASGE, reviewing Williams TJ, et al. Gastrointest Endosc 2024 Aug 13.
This is a single-center study of 242 colorectal lesions, ranging in size from 10 to 50 mm, all removed by piecemeal injection and cold snare resection (cold endoscopic mucosal resection [EMR]). There were 147 sessile serrated lesions (SSLs) and 95 adenomas resected in 151 patients.
For 10- to 19-mm lesions, recurrence rates at the 6-month follow-up were 3.0% for adenomas and 1.4% for SSLs (P = .5). The recurrence rates for lesions ≥20 mm were 16.1% for adenomas and 4.1% for SSLs (P = .02).
COMMENT
The low absolute recurrence rates for adenomas and SSLs in the 10 to 19 mm range help support the use of cold resection for all lesions in that category unless they are pedunculated, bulky, or have a morphology or other surface features associated with cancer (eg, the nongranular lesion with pseudo-depressed [Paris 2a + 2c] morphology or a lesion with Japan NBI Expert Team classification Type 2B or 3 surfaces changes). The next question for 10- to 19-mm lesions will be whether injection is actually necessary to achieve these results (I suspect not). The findings for lesions ≥20 mm are consistent with recent randomized trials.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
Douglas K. Rex, MD, MASGE
CITATION
Williams TJ, Mickenbecker M, Smith N, et al. Efficacy of cold piecemeal endoscopic mucosal resection of medium to large adenomas compared to sessile serrated lesions. Gastrointest Endosc 2024 Aug 13. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2024.08.008)
COMMENT
This study affirms important principles for FIT screening. First, cancers detected by FIT remain in an early stage during subsequent screening rounds. Further, increasing the cutoff level of hemoglobin for positive test results reduces sensitivity but does not shift the fraction of detected cancers substantially toward later-stage CRC. Thus, programs can adjust the cutoff to levels appropriate for their colonoscopy resources, and the detected cancers will be in an early stage across a range of hemoglobin thresholds for positive tests.