colonoscopy ? endoscopic mucosal resection ? local residual neoplasia

Piecemeal endoscopic mucosal resection (EMR) is frequently used for the treatment of non-poly poid colorectal lesions larger than 20 mm. Nevertheless, local residual neoplasia occurs (LRN) in as much as 15 % of cases. The aim of our prospective interventional study was to evaluate the efficacy of treatment of LRN under standardized conditions. Methods: In two high volume non-university endoscopy centers, LRN has been treated according to the newly proposed classification based on endoscopic appearance by argon plasma coagulation (APC), endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). Primary outcome, efficacy of LRN treatment, was defined as both endoscopic and histological absence of neoplastic tissue in the post-EMR site 6 months after LRN treatment session. Results: Twenty-five patients with 25 LRN lesions were enrolled. Among them, 12 (48 %), 8 (32 %) and 5 (20 %) were treated by APC, EMR and ESD, respectively, with efficacy in 10 (90.9 %),7 (87.5 %) and 4 (100 %), respectively. Conclusions: Using standardized approach based on therapy directed by LRN morphology, LRN may be eradicated in 91.3 % during one session.