Do Surface Morphology And Pit Pattern Have A Role In Predicting Cancer Forsessile Colon Polyps In North America?
*Ipek Sapci, *Michael Valente, *Matthew Kalady, *Alexandra Aiello, *Scott R Steele, *David Liska, Conor P. Delaney, Emre Gorgun
Cleveland Clinic, Cleveland, OH
OBJECTIVE(S): Correlation of submucosal invasion risk and endoscopic classifications based on lesion morphology and surface appearance has been described in the East, but not in North America. Our aim was to describe our experience with these advanced endoscopic resection techniques and investigate associations between the Paris classification, surface morphology and Kudo pit pattern to submucosal invasion risk.
METHODS: Consecutive EMR and ESD procedures performed on sessile polyps by a single colorectal surgeon between August 2017 and October 2018 were included in the study. Paris classification(Is, IIa, IIb, IIc, III), surface features (granular, nongranular, mixed) and Kudo pit patterns (I-V) were recorded prospectively. Patient demographics, lesion location, use of clip application, post-procedural complications and final pathology were collected. Multiple univariate analyses were conducted to compare characteristics across various groups.
RESULTS: 151 lesions were removed using EMR or ESD during the study period . Mean age was 66.7 ± 10 and median BMI was 29.0 [25.8, 34.4], and 53% of the patients were female. 138 lesions were included in the final analysis to assess the association between surface morphology and submucosal invasion. Median lesion size was 30 mm [25, 40] and the most common location was cecum (32%). On final pathology, 11 lesions had an invasive adenocarcinoma component (8%) and subsequently underwent oncological resections. Paris classification of IIa+c was associated with a higher submucosal invasion rate than the rest of the groups, and also had a high proportionof cancer. Surface morphology based on granularity was not associated with submucosal invasion (p=0.39). Kudo pit pattern V was significantly associated with submucosal invasion (p<0.001) and 54.5% of lesions with submucosal invasion had type V in the final pathology.
CONCLUSIONS: Submucosal invasion risk can be predicted in the North American patient population by using pit patterns in sessile colorectal lesions by an experienced advanced endoscopist. Accuracy in cancer risk assessment may lead to better selection of the optimal advanced endoscopic resection technique such as EMR or ESD for high risk lesions to ensure en-bloc and complete resection.
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