Endoscopy · 2026
Risk Stratification Model for Surveillance Interval Extension After Hot Endoscopic Mucosal Resection of Large Non-Pedunculated Colon Polyps.
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Garg Kanika, Wang Thomas J, Schwartz Benjamin, Maniak Agnieszka, Mehta Neal A, Chapman Christopher G, Melson Joshua, Rex Douglas K, Guardiola John J, Pleskow Douglas, Wallace Michael B, Gordon Stuart R, von Renteln Daniel, Khashab Mouen A, Ngamruengphong Saowanee, Gavrić Aleksandar, Yang Dennis, Levenick John, Moyer Matthew, Waxman Irving, Pohl Heiko, Singh Ajaypal
Аннотация
BACKGROUND: Current guidelines recommend uniform 6-month surveillance after endoscopic mucosal resection (EMR) of large non-pedunculated colon polyps (LNPCPs). We aimed to develop and validate a risk stratification model to identify lesions at lower recurrence risk.
METHODS: Retrospective multicenter study utilizing prospectively maintained databases across 12 centers (2017-2024) evaluated LNPCPs ≥20 mm removed by hot EMR. Twenty variables underwent multivariate Cox regression with stepwise selection to identify recurrence predictors. Validation was performed in a separate single-center cohort.
RESULTS: The derivation cohort included 463 patients with 491 LNPCPs. Multivariate analysis identified four independent predictors: evidence of prior resection (HR 1.97, 95% CI 1.04-3.72, p=0.03), absence of margin ablation (HR 1.96, 95% CI 1.22-3.23, p=0.01), villous histology (HR 1.77, 95% CI 1.09-2.86, p=0.02), and ileocecal valve (ICV) involvement (HR 2.66, 95% CI 1.29-5.45, p=0.01). Validation in a separate cohort (169 patients, 187 polyps) demonstrated effective risk stratification performance (p<0.01). In the validation cohort, low-risk polyps (no prior resection, margin ablation performed, no villous histology, no ICV involvement) had recurrence risks of 2.2%, 5.4%, and 9.7% at 6, 12, and 18 months respectively, compared to 10.6%, 23.1% and 28.1% in high-risk polyps. No patients in either cohort developed high-grade dysplasia or invasive adenocarcinoma during follow-up.
CONCLUSIONS: A simple four-factor model incorporating prior resection, margin ablation, villous histology, and ICV involvement stratifies recurrence detection risk after hot EMR. Absence of high-risk features may help identify patients at lower recurrence risk and provides a framework for future prospective studies evaluating risk-adapted surveillance strategies.
METHODS: Retrospective multicenter study utilizing prospectively maintained databases across 12 centers (2017-2024) evaluated LNPCPs ≥20 mm removed by hot EMR. Twenty variables underwent multivariate Cox regression with stepwise selection to identify recurrence predictors. Validation was performed in a separate single-center cohort.
RESULTS: The derivation cohort included 463 patients with 491 LNPCPs. Multivariate analysis identified four independent predictors: evidence of prior resection (HR 1.97, 95% CI 1.04-3.72, p=0.03), absence of margin ablation (HR 1.96, 95% CI 1.22-3.23, p=0.01), villous histology (HR 1.77, 95% CI 1.09-2.86, p=0.02), and ileocecal valve (ICV) involvement (HR 2.66, 95% CI 1.29-5.45, p=0.01). Validation in a separate cohort (169 patients, 187 polyps) demonstrated effective risk stratification performance (p<0.01). In the validation cohort, low-risk polyps (no prior resection, margin ablation performed, no villous histology, no ICV involvement) had recurrence risks of 2.2%, 5.4%, and 9.7% at 6, 12, and 18 months respectively, compared to 10.6%, 23.1% and 28.1% in high-risk polyps. No patients in either cohort developed high-grade dysplasia or invasive adenocarcinoma during follow-up.
CONCLUSIONS: A simple four-factor model incorporating prior resection, margin ablation, villous histology, and ICV involvement stratifies recurrence detection risk after hot EMR. Absence of high-risk features may help identify patients at lower recurrence risk and provides a framework for future prospective studies evaluating risk-adapted surveillance strategies.