IDDF2020-ABS-0095 Analysis of Predictive Factors for R0 Resection, Immediate Bleeding and Recurrence of Colorectal Adenomas after Endoscopic Mucosal Resection

Background Larger colonic polyps require advanced resection techniques such as endoscopic mucosal resection (EMR) for safe and effective removal. There has been a steady accumulation of scientific evidence with regards to the technical aspects and long-term outcomes of colonic EMR compared with surgery. This study aims to determine the predictive factors of different clinical outcomes post-EMR and the diagnostic yield of JNET classification. Methods A retrospective cohort study was done on all patients who underwent colorectal EMR at the St. Luke’s Medical Center Global City within a 4-year period from 2015 to 2018. The diagnostic yield of JNET classification and clinical outcomes namely R0 resection, complications and recurrence of lesions were studied. Results A total of 282 patients were studied. The R0 resection rate was 96.3% for lesions resected en bloc. 15.2% had a complication, most commonly intraprocedural bleeding which were successfully managed endoscopically. 10.7% had recurrence post-EMR on their surveillance colonoscopy. The JNET classification exhibited good sensitivity for Type 1 (71.8%) and Type 2A (91.9%) and good specificity for Type 1 (96.9%) and Type 2B (95.5%). Accuracy was high at 91.02% for Type 1, 80.24% for Type 2A and 89.22% for Type 2B. Conclusions EMR is an important advancement in the field of therapeutic endoscopy with good clinical outcomes sparing patients from surgery. A larger lesion size of >20 mm is associated with both positive resection margin and post-EMR complications. Main predictors of recurrence include a non-granular morphology of a resected polyp and piecemeal resection. The JNET classification has a high diagnostic accuracy rate; hence is a good endoscopic tool for characterization of lesions.