Endoscopic resection outcomes and predictors of failed en bloc endoscopic mucosal resection of colorectal polyps ≤ 20 mm among advanced endoscopy trainees.

Background and study aims  En bloc endoscopic mucosal resection (EMR) is preferred over piecemeal resection for polyps ≤ 20 mm. Data on colorectal EMR training are limited. We aimed to evaluate the en bloc EMR rate of polyps ≤ 20 mm among advanced endoscopy trainees and to identify predictors of failed en bloc EMR. Methods  This was a multicenter prospective study evaluating trainee performance in EMR during advanced endoscopy fellowship. A logistic regression model was used to identify the number of procedures and lesion cut-off size associated with an en bloc EMR rate of ≥ 80 %. Multivariate analysis was performed to identify predictors of failed en bloc EMR. Results  Six trainees from six centers performed 189 colorectal EMRs, of which 104 (55 %) were for polyps ≤ 20 mm. Of these, 57.7 % (60/104) were resected en bloc. Trainees with ≥ 30 EMRs (OR 6.80; 95 % CI: 2.80-16.50; P  = 0.00001) and lesions ≤ 17 mm (OR 4.56;95 CI:1.23-16.88; P  = 0.02) were more likely to be associated with an en bloc EMR rate of ≥ 80 %. Independent predictors of failed en bloc EMR on multivariate analysis included: larger polyp size (OR:6.83;95 % CI:2.55-18.4; P  = 0.0001), right colon location (OR:7.15; 95 % CI:1.31-38.9; P  = 0.02), increased procedural difficulty (OR 2.99; 95 % CI:1.13-7.91; P  = 0.03), and having performed < 30 EMRs (OR: 4.87; 95 %CI: 1.05-22.61; P  = 0.04). Conclusions  In this pilot study, we demonstrated that a relatively low proportion of trainees achieved en bloc EMR for polyps ≤ 20 mm and identified procedure volume and lesion size thresholds for successful en bloc EMR and independent predictors for failed en bloc resection. These preliminary results support the need for future efforts to define EMR procedure competence thresholds during training.
Competing Interests: Competing interests Dr. Yang is a consultant for Boston Scientific, Lumendi, and Steris Endoscopy. Dr. Draganov is a consultant for Boston Scientific, Olympus America, Cook Medical, Microtech, Steris Endoscopy, Merit, Lumendi, and Fujifilm. Dr. Wallace is a consultant for Virgo Inc, Cosmo/Aries Pharmaceuticals, Anx Robotica (2019), Covidien, GI Supply, Endokey, Endostart, Microtech, and Boston Scientific; has stock options with Virgo Inc; and receives research grants from Fujifilm, Boston Scientific, Olympus America, Medtronic, Ninepoint Medical, and Cosmo/Aries Pharmaceuticals. Dr. Gomez is a consultant for Olympus America. Dr. Bucobo is a consultant for Cook Medical. Dr. Trindade is a consultant for Pentax Medical and Olympus America and receives research support from Ninepoint Medical. Dr. Kumta is a consultant for Apollo Endosurgery, Boston Scientific, Gyrus ACMI Inc, GLG consulting, and Olympus. Dr. DiMaio is a consultant and teacher for Boston Scientific and Medtronic and a speaker for AbbVie. Dr. Pohl receives research grants from Steris and Cosmo/Aries Pharmaceuticals.
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