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1.
Dig Dis Sci ; 62(9): 2464-2471, 2017 09.
Article in English | MEDLINE | ID: mdl-28600656

ABSTRACT

BACKGROUND: Endoscopic experience is known to correlate with outcomes of endoscopic mucosal resection (EMR), particularly complete resection of the polyp tissue. Whether specialist endoscopists can protect against incomplete polypectomy in the setting of known risk factors for incomplete resection (IR) is unknown. AIMS: We aimed to characterize how specialist endoscopists may help to mitigate the risk of IR of large sessile polyps. METHODS: This is a retrospective cohort study of patients who underwent EMR at the University of Michigan from January 1, 2006, to November 15, 2015. The primary outcome was endoscopist-reported polyp tissue remaining at the end of the initial EMR attempt. Specialist endoscopists were defined as endoscopists who receive tertiary referrals for difficult colonoscopy cases and completed at least 20 EMR colonic polyp resections over the study period. RESULTS: A total of 257 patients with 269 polyps were included in the study. IR occurred in 40 (16%) cases. IR was associated with polyp size ≥ 40 mm [adjusted odds ratio (aOR) 3.31, 95% confidence interval (CI) 1.38-7.93], flat/laterally spreading polyps (aOR 2.61, 95% CI 1.24-5.48), and difficulty lifting the polyp (aOR 11.0, 95% CI 2.66-45.3). A specialist endoscopist performing the initial EMR was protective against IR, even in the setting of risk factors for IR (aOR 0.13, 95% CI 0.04-0.41). CONCLUSIONS: IR is associated with polyp size ≥ 40 mm, flat and/or laterally spreading polyps, and difficulty lifting the polyp. A specialist endoscopist initiating the EMR was protective of IR.


Subject(s)
Colonic Polyps/surgery , Endoscopic Mucosal Resection/methods , Endoscopic Mucosal Resection/trends , Specialization/trends , Aged , Cohort Studies , Colonic Polyps/diagnosis , Female , Follow-Up Studies , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors
2.
Gastrointest Endosc ; 78(5): 696-701, 2013 Nov.
Article in English | MEDLINE | ID: mdl-23711553

ABSTRACT

BACKGROUND: Despite the increasing number of patients undergoing endoscopic therapy for Barrett's esophagus (BE) with high-grade dysplasia (HGD) or intramucosal cancer (IMC), there are few data to guide clinical decision making and research initiatives in the area of posttreatment follow-up. OBJECTIVES: We aimed to define expert practice patterns regarding follow-up after endoscopic treatment of BE with HGD and IMC. DESIGN: Electronic survey. SUBJECTS: Forty-eight endoscopists in the United States with expertise in BE endotherapy based on high-impact publications and national reputation. INTERVENTION: A 21-item Web-based survey inquiring about post-BE endotherapy follow-up practices. RESULTS: Of 48 expert endoscopists, 42 completed the survey. After successful treatment of BE with HGD or IMC, all experts perform surveillance upper endoscopy, most commonly at 3-month intervals in the first posttreatment year, every 6 months during the second year, and annually thereafter. None of the experts perform surveillance EUS after treatment of HGD, and only 19% perform EUS after treatment of IMC. After cancer eradication, only 36% of experts refer patients for CT, and 24% refer patients for positron emission tomography. Thirty-eight percent of experts refer patients for a surgical opinion when IMC extends into the muscularis mucosa; 100% refer when IMC extends into submucosa. LIMITATIONS: Not a consensus document; only U.S. experts included. CONCLUSIONS: This study reports the follow-up practices of expert endoscopists after successful endotherapy for BE with HGD and IMC. Additional research is necessary to establish optimal surveillance intervals, the role of follow-up EUS, CT, and positron emission tomography, as well as the surgical implications of low-risk IMC extending into the muscularis mucosa.


Subject(s)
Adenocarcinoma/surgery , Aftercare/methods , Barrett Esophagus/surgery , Esophageal Neoplasms/surgery , Gastroenterology/statistics & numerical data , Neoplasm Recurrence, Local/diagnosis , Adenocarcinoma/complications , Barrett Esophagus/complications , Barrett Esophagus/pathology , Esophageal Neoplasms/complications , Esophagoscopy/statistics & numerical data , Humans , Neoplasm Grading , Positron-Emission Tomography/statistics & numerical data , Practice Patterns, Physicians' , Referral and Consultation/statistics & numerical data , Surveys and Questionnaires , Tomography, X-Ray Computed/statistics & numerical data , Treatment Outcome , United States
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