Colorectal polyps located across a fold are difficult to resect completely using endoscopic mucosal resection: A propensity score analysis

Hiroaki Minamino; Yasuaki Nagami; Masatsugu Shiba; Kappei Hayashi; Taishi Sakai; Masaki Ominami; Shusei Fukunaga; Tsuyoshi Hayakawa; Kazuki Aomatsu; Satoshi Sugimori; Tetsuya Tanigawa; Hirokazu Yamagami; Toshio Watanabe; Yasuhiro Fujiwara

doi:10.1177/2050640618797854

Colorectal polyps located across a fold are difficult to resect completely using endoscopic mucosal resection: A propensity score analysis

United European Gastroenterol J. 2018 Dec;6(10):1547-1555. doi: 10.1177/2050640618797854. Epub 2018 Aug 24.

Authors

Affiliations

¹ Department of Gastroenterology, Baba Memorial Hospital 4-244, Sakai City, Japan.
² Department of Gastroenterology, Osaka City University Graduate School of Medicine 1-4-3, Osaka, Japan.
³ Department of Gastroenterology, Izumiotsu Municipal Hospital 16-1, Izumiotsu City, Japan.

Abstract

Background: Incomplete polyp resection during colorectal endoscopic mucosal resection (EMR) might contribute to the development of interval cancer.

Objective: This retrospective study aimed to determine the incidence of incomplete polyp resection during EMR of colorectal polyps located across a fold compared with that of colorectal polyps located between folds.

Methods: In total, 262 patients with 262 lesions that were ≥10 mm in diameter and treated with conventional EMR were enrolled. The main outcome was the incidence of incomplete polyp resections. Propensity score matching and inverse probability of treatment weighting (IPTW) were performed to reduce the effects of selection bias.

Results: Fifty-seven lesions (21.8%) were incompletely resected. After propensity score matching, the lesions located across a fold were at higher risk of incomplete resection than those between folds (26/68, 38.2% vs 7/68, 10.3%; odds ratio (OR): 3.71; 95% confidence interval (CI): 1.61-8.56; p < 0.01). These findings persisted after adjusting for the differences at baseline using the IPTW method (OR: 3.63; 95% CI: 1.72-7.63; p = 0.001).

Conclusions: There is an increased risk of an incomplete polyp resection for a colorectal polyp that is located across a fold compared with that for a polyp that is located between folds.

Keywords: Colorectal polyp; endoscopic mucosal resection; endoscopic resection; incomplete resection; inverse probability of treatment weighting; polypectomy.