The size, morphology, site, and access score predicts critical outcomes of endoscopic mucosal resection in the colon
- 25 January 2018
- journal article
- research article
- Published by Georg Thieme Verlag KG in Endoscopy
- Vol. 50 (07), 684-692
- https://doi.org/10.1055/s-0043-124081
Abstract
Background The SMSA (size, morphology, site, access) polyp scoring system is a method of stratifying the difficulty of polypectomy through assessment of four domains. The aim of this study was to evaluate the ability of SMSA to predict critical outcomes of endoscopic mucosal resection (EMR). Methods We retrospectively applied SMSA to a prospectively collected multicenter database of large colonic laterally spreading lesions (LSLs) ≥ 20 mm referred for EMR. Standard inject-and-resect EMR procedures were performed. The primary end points were correlation of SMSA level with technical success, adverse events, and endoscopic recurrence. Results 2675 lesions in 2675 patients (52.6 % male) underwent EMR. Failed single-session EMR occurred in 124 LSLs (4.6 %) and was predicted by the SMSA score (P < 0.001). Intraprocedural and clinically significant postendoscopic bleeding was significantly less common for SMSA 2 LSLs (odds ratio [OR] 0.36, P < 0.001 and OR 0.23, P < 0.01) and SMSA 3 LSLs (OR 0.41, P < 0.001 and OR 0.60, P = 0.05) compared with SMSA 4 lesions. Similarly, endoscopic recurrence at first surveillance was less likely among SMSA 2 (OR 0.19, P < 0.001) and SMSA 3 (OR 0.33, P < 0.001) lesions compared with SMSA 4 lesions. This also extended to second surveillance among SMSA 4 LSLs. Conclusion SMSA is a simple, readily applicable, clinical score that identifies a subgroup of patients who are at increased risk of failed EMR, adverse events, and adenoma recurrence at surveillance colonoscopy. This information may be useful for improving informed consent, planning endoscopy lists, and developing quality control measures for practitioners of EMR, with potential implications for EMR benchmarking and training. * These authors contributed equally to this work.Keywords
This publication has 27 references indexed in Scilit:
- Risk Stratification System for Evaluation of Complex Polyps Can Predict Outcomes of Endoscopic Mucosal ResectionDiseases of the Colon & Rectum, 2013
- Snare tip soft coagulation achieves effective and safe endoscopic hemostasis during wide-field endoscopic resection of large colonic lesions (with videos)Gastrointestinal Endoscopy, 2013
- A novel method for determining the difficulty of colonoscopic polypectomyFrontline Gastroenterology, 2013
- Carbon dioxide insufflation reduces number of postprocedure admissions after endoscopic resection of large colonic lesions: a prospective cohort studyGastrointestinal Endoscopy, 2013
- European guidelines for quality assurance in colorectal cancer screening and diagnosis. First Edition – Quality assurance in endoscopy in colorectal cancer screening and diagnosisEndoscopy, 2012
- Endoscopic Mucosal Resection Outcomes and Prediction of Submucosal Cancer From Advanced Colonic Mucosal NeoplasiaGastroenterology, 2011
- Factors that predict bleeding following endoscopic mucosal resection of large colonic lesionsEndoscopy, 2011
- Systematic review: distribution of advanced neoplasia according to polyp size at screening colonoscopyAlimentary Pharmacology & Therapeutics, 2009
- POSSUM and Portsmouth POSSUM for predicting mortalityBritish Journal of Surgery, 1998
- POSSUM: A scoring system for surgical auditBritish Journal of Surgery, 1991