Safety of endoscopic mucosal resection (EMR) of large non-pedunculated colorectal adenomas in the elderly

• Published in: International journal of colorectal disease Vol. 32; no. 12; pp. 1711 - 1717
• Main Authors: Bronsgeest, K., Huisman, J. F., Langers, A., Boonstra, J. J., Schenk, B. E., de Vos tot Nederveen Cappel, W. H., Vasen, H. F. A., Hardwick, J. C. H.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-12-2017; Springer; Springer Nature B.V
• Subjects: Adenomatous Polyps - pathology; Adenomatous Polyps - surgery; Age Factors; Aged; Aged patients; Bleeding; Blood Loss, Surgical; Care and treatment; Colonic Polyps - pathology; Colonic Polyps - surgery; Colorectal Neoplasms - pathology; Colorectal Neoplasms - surgery; Demography; Drug Administration Schedule; Drugs; Electronic records; Endoscopic Mucosal Resection - adverse effects; Endoscopy; Female; Fibrinolytic Agents - administration & dosage; Fibrinolytic Agents - adverse effects; Gastroenterology; Geriatrics; Hepatology; Humans; Internal Medicine; Intestinal Perforation - etiology; Male; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Middle Aged; Mucosa; Netherlands; Original; Original Article; Polyps; Postoperative Hemorrhage - etiology; Proctology; Retrospective Studies; Risk Factors; Safety and security measures; Surgery; Time Factors; Treatment Outcome; Tumor Burden; Tumors; Giant adenomas; Colorectal adenomas; Perforations; Complications; Non-pedunculated adenomas; Endoscopic mucosal resection; EMR; Elderly; Bleeding
• ISSN: 0179-1958; 1432-1262
• DOI: 10.1007/s00384-017-2892-7

Background
Endoscopic mucosal resection (EMR) has been proven to be safe and effective for the treatment of colorectal adenomas. However, data are limited on the safety of this technique for large polyps and in elderly patients. Aims of our study were to examine the bleeding and perforation rates in patients with large non-pedunculated adenomas (≥20mm) and to evaluate the influence of size (≥40mm) and age (≥75 years) on the complication rates.
Methods
In this multicenter retrospective study, patients who underwent EMR of non-pedunculated adenomas ≥20mm between January 2012 and March 2016 were included. The demographics of the patients, the use of antithrombotic drugs, size of the polyps, type of resection, pathology report, occurrence of post-polypectomy bleeding, and perforation- and recurrence rate were collected.
Results
In 343 patients, 412 adenomas were removed. Eighty patients (23.3%) were ≥75 years of age, 138 polyps (33.5%) were ≥40mm. Bleeding complications were observed in 28 cases (6.8%) and were found significantly more frequent in adenomas ≥40mm, independent of the use of antithrombotic therapy. Five perforations (1.2%) were described, not related to the size of the polyp. There was no significant difference in complication rates between patients <75 years and patients ≥75 years. Bleeding complications rates were significantly higher in patients receiving double antithrombotic therapy.
Conclusion
EMR is safe in elderly patients. EMR of adenomas of ≥40mm was associated with more bleeding complications. Future studies should address how the bleeding rates can be reduced in these patients, especially in those who use double antithrombotic treatment.