Post written by David J. Tate, MBBS, MRCP, PhD, from the Department of Gastroenterology and Hepatology, University Hospital of Ghent, Ghent, Belgium, and the Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia.

This study primarily focuses on identifying incomplete mucosal layer excision during EMR and understanding its role as a potential risk factor for recurrence of adenoma.

The research investigates the post—endoscopy resection defect to determine whether incomplete mucosal excision could predict the likelihood of adenoma recurrence.

Recurrence after EMR is a known issue, and although thermal ablation of the post—resection margin has been shown to reduce recurrence rates, recurrence despite this intervention prompted further investigation. This study aimed to identify whether specific features within the post—endoscopic resection defect, such as incomplete mucosal layer excision, could serve as predictors for recurrence, thereby guiding better clinical practice.

The study found that incomplete mucosal layer excision occurred in 2% of cases involving large colorectal polyps and that, of these cases, 90% contained residual lamina propria and 50% residual adenoma. This suggests that incomplete mucosal excision can be a significant marker for recurrence, necessitating closer examination and potential resection of these areas during the initial procedure to reduce risk of recurrence. This study highlights the importance of careful post—resection defect examination to identify and manage this risk factor.

Future research should focus on understanding the reasons behind variations in recurrence rates among practitioners and further explore the correlation between incomplete excision and recurrence in a broader, multicenter context.

This study underscores the importance of meticulous technique during EMR and the potential need for enhanced training for endoscopists to recognize and address incomplete mucosal excision. Moreover, the study suggests that patients with multiple areas of incomplete excision might benefit from closer follow-up or earlier surveillance to manage risk of recurrence.

Images of EMR procedures in which incomplete mucosal layer excision (IME) occurred. Dotted lines indicate borders between residual muscularis mucosae and submucosal defect and therefore demarcate areas of IME. Letters on the panels describe the displayed appearances. A, Residual adenoma; mm, muscularis mucosae; wel, white electrocautery line; lc, lacy capillaries; m, residual mucosa.

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