Masterclass Colonoscopy: Trends and Recommendations Forward (Virtual)

Video Transcription

Video Summary

Recurrence is not uncommon after endoscopic mucosal resection (EMR), with rates ranging from 14% to 18%. Risk factors for recurrence include larger lesion size, difficult to access locations, sessile depressed morphology, non-lifting areas, interprocedural bleeding, advanced histology, high-grade dysplasia, and previous use of argon plasma coagulation. Several scoring systems have been developed to predict recurrence, including the ASSERT score and the SMSA score. Risk of recurrence can be reduced through proper technique during EMR and treatment of the margin. Techniques for treating recurrence include snare cautery, avulsion, underwater EMR, cap-assisted EMR, and full thickness resection devices. Treatment should be followed by ablation of the margin to reduce the risk of recurrence further. Other methods such as FTRD and endorotor are still being investigated and are not yet commonly used. It is important to differentiate recurrence from post-clipping artifacts and to biopsy the scar to confirm. In the majority of cases, recurrences can be successfully treated by endoscopic methods, reducing the need for surgery. Follow-up colonoscopies are necessary to monitor for late recurrence.

Asset Subtitle

Amit Rastogi, MD, FASGE

Keywords

endoscopic mucosal resection

recurrence rates

risk factors

scoring systems

treatment techniques

margin ablation

follow-up colonoscopies