Actual endoscopic versus predicted surgical mortality for treatment of advanced mucosal neoplasia of the colon
Date
2014
Authors
Ahlenstiel, G.
Hourigan, L.
Brown, G.
Zanati, S.
Williams, S.
Singh, R.
Moss, A.
Sonson, R.
Bourke, M.
Australian Colonic Endoscopic Mucosal Resection (ACE) Study Group,
Editors
Advisors
Journal Title
Journal ISSN
Volume Title
Type:
Journal article
Citation
Gastrointestinal Endoscopy, 2014; 80(4):668-676
Statement of Responsibility
Golo Ahlenstiel, Luke F. Hourigan, Gregor Brown, Simon Zanati, Stephen J. Williams, Rajvinder Singh, Alan Moss, Rebecca Sonson, Michael J. Bourke, The Australian Colonic Endoscopic Mucosal Resection, ACE, Study Group
Conference Name
Abstract
Background: EMR of advanced mucosal neoplasia (AMN) (ie, sessile or laterally spreading lesions of R20 mm) of the colon has become an increasingly popular alternative to surgical resection. However, data regarding safety and mortality of EMR in comparison to surgery are limited. Objective: To compare actual endoscopic with predicted surgical mortality. Design: Prospective, observational, multicenter cohort study. Setting: Academic, high-volume, tertiary-care referral center. Patients: Consecutive patients referred for EMR. Intervention: EMR. Main Outcome Measurements: To predict hypothetical surgical mortality, the Association of Coloproctology of Great Britain and Ireland score, composed of physiological and surgical components, was calculated for each patient. Predicted surgical mortality was then compared with actual outcomes of EMR. The results were validated by an unselected subcohort by using the Colorectal Physiologic and Operative Severity Score for Enumeration of Mortality and Morbidity. Results: Among 1050 patients with AMN treated by EMR, including patients with a predicted mortality rate of greater than 5% (13.8% of cohort), no deaths occurred within 30 days after the procedure. The predicted surgical mortality rate was 3.3% with the Association of Coloproctology of Great Britain and Ireland score (P!.0001). This suggests a significant advantage of EMR over surgery. The results were validated by using the Colorectal Physiologic and Operative Severity Score for Enumeration of Mortality and Morbidity in 390 patients predicting a surgical mortality rate of 3.2% (P Z .0003). Limitations: Nonrandomized study. Conclusion: In this large multicenter study of EMR for colonic AMN, the predicted surgical mortality rate was significantly higher than the actual endoscopic mortality rate. Given that endoscopic therapy is less morbid and less expensive than surgery and can be performed as an outpatient treatment, it should be considered as the first line of treatment for most patients with these lesions. (Gastrointest Endosc 2014;80:668-76.)
School/Discipline
Dissertation Note
Provenance
Description
Access Status
Rights
Copyright © 2014 by the American Society for Gastrointestinal Endoscopy