Work

Extended surveillance after piecemeal endoscopic mucosal resection: a safe approach to initial surveillance in low-risk patients

Year: 2025

Type: article

Abstract: BACKGROUND AND AIMS: Piecemeal endoscopic mucosal resection (EMR) is the standard of care for large, nonpedunculated colon polyps but is associated with recurrence rates of 9% to 31%. Current guidelines recommend 6-month surveillance for all patients, although this may not be necessary for lower-risk cases. METHODS: We retrospectively reviewed patients who underwent piecemeal EMR of ≥20-mm colon polyps between 2018 and 2021. Patients were stratified into 6- or 12-month surveillance groups based on polyp features. Recurrence rates and associated factors were compared. RESULTS: Among 193 patients, recurrence was higher in the 6-month (31.5%) than in the 12-month group (14.3%, P < .05). Among patients with recurrence, the 6-month follow-up group had more tubulovillous adenomas (P < .05) on index colonoscopy. Tubulovillous histology in the initial polyp was the only factor associated with recurrence. CONCLUSIONS: A risk-stratified approach may safely extend surveillance to 12 months for lower-risk patients after piecemeal EMR, reducing unnecessary procedures without compromising care.

Source: Gastrointestinal Endoscopy

DOI: 10.1016/j.gie.2025.10.021