Similar Rates of Histologic-Confirmed Recurrence After Endoscopic Mucosal Resection (EMR) of Non-Pedunculated Polyps Among General Gastroenterologists and Advance Endoscopists

Introduction: Endoscopic mucosal resection (EMR) technique is the most common approach for non-pedunculated colonic polyps ≥20 mm. EMR is usually performed by both general gastroenterologists and advance endoscopists. EMR performed by advanced endoscopists have been associated with decreased risk of incomplete polyp resection, but little is known about the recurrence rate of large non-pedunculated polyps performed by general gastroenterologists. Thus, we aim to investigate recurrence rate and EMR characteristics for non-pedunculated polyps ≥20 mm performed by general gastroenterologists. Methods: Retrospective study of patients who undergone EMR of non-pedunculated polyps ≥20 mm at Ben Taub and Veteran’s Affairs (VA) hospital in Houston, Texas from 2012 to 2019. Patients who had two stage procedures, non-neoplastic histology or evidence of invasive cancer were excluded. Patients were divided by type of endoscopist who performed index colonoscopy. Demographic data, polyp and resection characteristics were analyzed. Univariate and multivariate analyzed were performed. Results: A total of 522 non-pedunculated polyps were included from 470 unique patients. 271 polyps had EMR performed by general gastroenterologists and 199 polyps by advance endoscopists. 177 lesions in the general gastroenterologist group completed at least 1 surveillance colonoscopy, 49 (27.7%) had histologic recurrence. 150 lesions in the advance endoscopists group completed at least 1 surveillance colonoscopy, 46 (30.7%) had histologic recurrence. The average polyp size of the cohort was 28.6 mm. Polyps from male patients (85.6% vs 74.4%, P = 0.002) at the VA hospital (82.7% vs 55.3%, P ≤ 0.001) were more likely to be resected by general gastroenterologists. Other demographic characteristics were comparable among groups. There were no significant differences between groups in polyp size, histological recurrence, delayed post-polypectomy bleeding and/or post procedural pain prompting abdominal imaging. Advance endoscopists were more likely to use clips for prophylactic defect closure and less likely to have intraprocedural bleeding (Table 1). Conclusion: General gastroenterologists had a similar recurrence rate after EMR of non-pedunculated polyps ≥20 mm compared with advanced endoscopists. Advance endoscopists had less intraprocedural bleeding but delayed post-polypectomy bleeding rate was comparable.Table 1.: Univariable and multivariable logistic regression analysis of polyp resection characteristics