Endoscopic mucosal resection in high- and low-volume centers: A prospective multicentric study

E. Masci, E. Viale, C. Notaristefano, B. Mangiavillano, G. Fiori, C. Crosta, M. Dinelli, M. Maino, P. Viaggi, F. Della Giustina, V. Teruzzi, G. Grasso, G. Manes, S. Zambelli, P. A. Testoni

Research output: Contribution to journalArticle

Abstract

Background: Endoscopic mucosal resection (EMR) is an effective therapeutic technique well-standardized worldwide for the treatment of gastrointestinal neoplasm limited to the mucosal layer. To date, no study has compared technical and clinical differences based on the number of EMRs performed per year. This study aimed to compare EMR technical success, complications, and clinical outcome between low-volume centers (LVCs) and high-volume centers (HVCs). A total of nine endoscopic centers were included in the study. Methods: This prospective study investigated consecutive patients with sessile polyps or flat colorectal lesions 1 cm or larger referred for EMR. Results: A total of 427 lesions were resected in 384 patients at nine endoscopic centers. Males accounted for 60.4 % and females for 39.6 % of the patients. Most of the EMRs (84.8 %) were performed in HVCs and only 15.2 % in LVCs. All the lesions were resected in only one session. Argon plasma coagulation was performed on the margins of piecemeal resection in 15.7 % of the patients in HVCs only. Complete excision was achieved for 98.6 % of the lesions in HVCs and 98.8 % of the lesions in LVCs. The complication rate was 4.4 % in HVCs and 4.6 % in LVCs (p = 0.94). Delayed bleeding occurred in 2.5 % of the HVC cases and 3.1 % of the LVC cases. Perforation occurred in 1.9 % of the HVC cases and 1.5 % of the LVC cases (p = 1.00). Recurrences were experienced with 15 % of the lesions: 15.5 % in HVCs and 14 % in LVCs (p = 0.79). Conclusions: The study showed that EMR can be performed also in LVC.

Original languageEnglish
Pages (from-to)3799-3805
Number of pages7
JournalSurgical Endoscopy and Other Interventional Techniques
Volume27
Issue number10
DOIs
Publication statusPublished - Oct 2013

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Prospective Studies
Argon Plasma Coagulation
Gastrointestinal Neoplasms
Polyps
Hemorrhage
Recurrence
Endoscopic Mucosal Resection
Therapeutics
Margins of Excision

Keywords

  • EMR
  • Endoscopic mucosal resection
  • High-volume centers
  • Low-volume centers

ASJC Scopus subject areas

  • Surgery

Cite this

Endoscopic mucosal resection in high- and low-volume centers : A prospective multicentric study. / Masci, E.; Viale, E.; Notaristefano, C.; Mangiavillano, B.; Fiori, G.; Crosta, C.; Dinelli, M.; Maino, M.; Viaggi, P.; Della Giustina, F.; Teruzzi, V.; Grasso, G.; Manes, G.; Zambelli, S.; Testoni, P. A.

In: Surgical Endoscopy and Other Interventional Techniques, Vol. 27, No. 10, 10.2013, p. 3799-3805.

Research output: Contribution to journalArticle

Masci, E, Viale, E, Notaristefano, C, Mangiavillano, B, Fiori, G, Crosta, C, Dinelli, M, Maino, M, Viaggi, P, Della Giustina, F, Teruzzi, V, Grasso, G, Manes, G, Zambelli, S & Testoni, PA 2013, 'Endoscopic mucosal resection in high- and low-volume centers: A prospective multicentric study', Surgical Endoscopy and Other Interventional Techniques, vol. 27, no. 10, pp. 3799-3805. https://doi.org/10.1007/s00464-013-2977-5
Masci, E. ; Viale, E. ; Notaristefano, C. ; Mangiavillano, B. ; Fiori, G. ; Crosta, C. ; Dinelli, M. ; Maino, M. ; Viaggi, P. ; Della Giustina, F. ; Teruzzi, V. ; Grasso, G. ; Manes, G. ; Zambelli, S. ; Testoni, P. A. / Endoscopic mucosal resection in high- and low-volume centers : A prospective multicentric study. In: Surgical Endoscopy and Other Interventional Techniques. 2013 ; Vol. 27, No. 10. pp. 3799-3805.
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abstract = "Background: Endoscopic mucosal resection (EMR) is an effective therapeutic technique well-standardized worldwide for the treatment of gastrointestinal neoplasm limited to the mucosal layer. To date, no study has compared technical and clinical differences based on the number of EMRs performed per year. This study aimed to compare EMR technical success, complications, and clinical outcome between low-volume centers (LVCs) and high-volume centers (HVCs). A total of nine endoscopic centers were included in the study. Methods: This prospective study investigated consecutive patients with sessile polyps or flat colorectal lesions 1 cm or larger referred for EMR. Results: A total of 427 lesions were resected in 384 patients at nine endoscopic centers. Males accounted for 60.4 {\%} and females for 39.6 {\%} of the patients. Most of the EMRs (84.8 {\%}) were performed in HVCs and only 15.2 {\%} in LVCs. All the lesions were resected in only one session. Argon plasma coagulation was performed on the margins of piecemeal resection in 15.7 {\%} of the patients in HVCs only. Complete excision was achieved for 98.6 {\%} of the lesions in HVCs and 98.8 {\%} of the lesions in LVCs. The complication rate was 4.4 {\%} in HVCs and 4.6 {\%} in LVCs (p = 0.94). Delayed bleeding occurred in 2.5 {\%} of the HVC cases and 3.1 {\%} of the LVC cases. Perforation occurred in 1.9 {\%} of the HVC cases and 1.5 {\%} of the LVC cases (p = 1.00). Recurrences were experienced with 15 {\%} of the lesions: 15.5 {\%} in HVCs and 14 {\%} in LVCs (p = 0.79). Conclusions: The study showed that EMR can be performed also in LVC.",
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AU - Masci, E.

AU - Viale, E.

AU - Notaristefano, C.

AU - Mangiavillano, B.

AU - Fiori, G.

AU - Crosta, C.

AU - Dinelli, M.

AU - Maino, M.

AU - Viaggi, P.

AU - Della Giustina, F.

AU - Teruzzi, V.

AU - Grasso, G.

AU - Manes, G.

AU - Zambelli, S.

AU - Testoni, P. A.

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N2 - Background: Endoscopic mucosal resection (EMR) is an effective therapeutic technique well-standardized worldwide for the treatment of gastrointestinal neoplasm limited to the mucosal layer. To date, no study has compared technical and clinical differences based on the number of EMRs performed per year. This study aimed to compare EMR technical success, complications, and clinical outcome between low-volume centers (LVCs) and high-volume centers (HVCs). A total of nine endoscopic centers were included in the study. Methods: This prospective study investigated consecutive patients with sessile polyps or flat colorectal lesions 1 cm or larger referred for EMR. Results: A total of 427 lesions were resected in 384 patients at nine endoscopic centers. Males accounted for 60.4 % and females for 39.6 % of the patients. Most of the EMRs (84.8 %) were performed in HVCs and only 15.2 % in LVCs. All the lesions were resected in only one session. Argon plasma coagulation was performed on the margins of piecemeal resection in 15.7 % of the patients in HVCs only. Complete excision was achieved for 98.6 % of the lesions in HVCs and 98.8 % of the lesions in LVCs. The complication rate was 4.4 % in HVCs and 4.6 % in LVCs (p = 0.94). Delayed bleeding occurred in 2.5 % of the HVC cases and 3.1 % of the LVC cases. Perforation occurred in 1.9 % of the HVC cases and 1.5 % of the LVC cases (p = 1.00). Recurrences were experienced with 15 % of the lesions: 15.5 % in HVCs and 14 % in LVCs (p = 0.79). Conclusions: The study showed that EMR can be performed also in LVC.

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