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• W3099687524 abstract "We read with great interest the article by Tate et al,1Tate D.J. Sidhu M. Bar-Yishay I. et al.Impact of en bloc resection on long-term outcomes after endoscopic mucosal resection: a matched cohort study.Gastrointest Endosc. 2020; 91: 1155-1163.e1Abstract Full Text Full Text PDF Scopus (8) Google Scholar who described long-term outcomes after EMR for 20- to 25-mm colorectal polyps. They concluded that en bloc EMR (e-EMR) offers no advantage and should be avoided because of comparably low recurrence rates between piecemeal EMR (p-EMR) and e-EMR (2.4% vs 1.4%, P = .49) at 18-month surveillance colonoscopy (SC) and increased perforation in e-EMR. We are concerned that the authors’ conclusions can mislead readers because of inappropriate interpretation of the data. Therefore, we present alternatives to their conclusions. First, p-EMR caused significantly more recurrence than e-EMR at the 6-month SC (5.7% vs 2.0%, P = .04). We should not underestimate this because these recurrences can develop into postcolonoscopy colorectal cancer (PCCRC) when SC adherence is suboptimal.2Belderbos T.D. Pullens H.J. Leenders M. et al.Risk of post-colonoscopy colorectal cancer due to incomplete adenoma resection: a nationwide, population-based cohort study.United European Gastroenterol J. 2017; 5: 440-447Crossref PubMed Scopus (13) Google Scholar, 3Adler J. Toy D. Anderson J.C. et al.Metachronous neoplasias arise in a higher proportion of colon segments from which large polyps were previously removed, and can be used to estimate incomplete resection of 10-20 mm colorectal polyps.Clin Gastroenterol Hepatol. 2019; 17: 2277-2284Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar, 4Adler J. Robertson D.J. Interval colorectal cancer after colonoscopy: exploring explanations and solutions.Am J Gastroenterol. 2015; 110: 1657-1664Crossref PubMed Scopus (66) Google Scholar, 5le Clercq C.M. Winkens B. Bakker C.M. et al.Metachronous colorectal cancers result from missed lesions and non-compliance with surveillance.Gastrointest Endosc. 2015; 82: 325-333 e2Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar Second, short-interval SC is needed after p-EMR to reduce recurrence (5.7% at 6 months and 2.4% at 18 months) but seems insignificant after e-EMR (2.0% at 6 months and 1.0% at 18 months). Therefore, e-EMR prevents recurrence and, subsequently, PCCRC and can eliminate the need for short-interval SC. This interpretation contradicts their conclusion that e-EMR offered no advantage. One finding potentially leads to this inappropriate interpretation of data. They reported 90% adherence to 6-month SC, but the real-world data have a high no-surveillance rate of 33% to 57%.6Murphy C.C. Sandler R.S. Grubber J.M. et al.Underuse and overuse of colonoscopy for repeat screening and surveillance in the Veterans Health Administration.Clin Gastroenterol Hepatol. 2016; 14: 436-444 e1Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar, 7Van Heijningen E.M.B. Lansdorp-Vogelaar I. Steyerberg E.W. et al.Adherence to surveillance guidelines after removal of colorectal adenomas: a large, community-based study.Gut. 2015; 64: 1584-1592Crossref PubMed Scopus (57) Google Scholar, 8Schoen R.E. Pinsky P.F. Weissfeld J.L. et al.Utilization of surveillance colonoscopy in community practice.Gastroenterology. 2010; 138: 73-81Abstract Full Text Full Text PDF PubMed Scopus (167) Google Scholar Thus, the long-term, low recurrence rate after p-EMR in this study was likely affected more by the excellent adherence to SC than by successful p-EMR. Nevertheless, the authors should be congratulated because they clarify that e-EMR is beneficial even for lesions 20 to 25 mm, meaning that efforts to increase en bloc resection rates in these lesions are not in vain. We agree with the authors’ caution that endoscopic submucosal dissection is difficult to balance for such lesions; therefore, we share the goal of developing easy and convenient modifications for snare resection to improve en bloc resection for 20- to 25-mm lesions in future studies. All authors disclosed no financial relationships. ResponseGastrointestinal EndoscopyVol. 92Issue 6PreviewWe thank Imai et al1 for their letter concerning our article.2 Full-Text PDF" @default.
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• W3099687524 title "Piecemeal resection of 20- to 25-mm colorectal polyps necessitates short-term surveillance colonoscopy to reduce local recurrence similar to en bloc removal" @default.
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• W3099687524 doi "https://doi.org/10.1016/j.gie.2020.06.074" @default.
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