P4500 - EMR vs ESD for Large Polyps (>20mm)

Mayank Goyal, MBBS¹, Fnu Deepali, MBBS¹, Anmol Bains, MBBS¹, Ashwariya Ohri, MBBS¹, Khushboo Gala, MBBS², Navtej Buttar, MD^1
1Mayo Clinic, Rochester, MN; ²Mayo Clinic School of Graduate Medical Education, Rochester, MN

Introduction: EMR and ESDs are 2 endoscopic procedures used to treat polyps in the gut. We aim to compare the relative safety and efficacy of both these techniques for treatment of large polyps( >20mm) in the rectum and rectosigmoid.

Methods: : this is a systematic review of electronic medical records of consecutive patients > 18 years old who underwent EMR or ESD procedures for large rectal polyps( >20mm) at a tertiary care center from 2011 to 2021. Patient demographics, procedural details and follow up findings were collected.

Results: A total of 112 patients (mean age 65.51±13.62; 50.9% men) underwent EMR (63/112, 56.3%) and ESD (49/112, 43.8%) procedures. Of these 112, 88(78.6%) were in the rectum and 24(21.4%) were in the rectosigmoid. Adjunctive therapy was used in 42/112(66.7%) of EMR and 24/49(24.5%) ESDs. Immediate complications were seen in 3/63(4.8%) EMR cases and 2/49(4.1%) ESD cases. Delayed complications were more frequent than immediate ones and were seen in 7/63(11.1%) EMR patients and 4/49(8.2%) ESD patients. Incomplete resection was noted in 5/112(4.5%) polypectomies. 7/63(11.1%) of the polyps treated by EMR showed a recurrence with a median time to recurrence of 190.00 days while 2/49(5.3%) polyps treated by ESD showed recurrence and had a median time to recurrence of 1036.50 days.

Discussion: There was no significant difference between recurrence-free survival between the two groups(p=0.19). Both EMR and ESD are safe and effective for the resection of large rectal polyps. However, to overcome selection bias, a randomized trial of EMR vs ESD for rectal polyps is warranted.



Disclosures:


Mayank Goyal, MBBS¹, Fnu Deepali, MBBS¹, Anmol Bains, MBBS¹, Ashwariya Ohri, MBBS¹, Khushboo Gala, MBBS², Navtej Buttar, MD¹. P4500 - EMR vs ESD for Large Polyps (>20mm), ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.