Standardised training for endoscopic mucosal resection of large non-pedunculated colorectal polyps to reduce recurrence (*STAR-LNPCP study): a multicentre cluster randomised trial
Meulen, Lonne W T; Bogie, Roel M M; Siersema, Peter D; Winkens, Bjorn; Vlug, Marije S; Wolfhagen, Frank H J; Baven-Pronk, Martine; van der Voorn, Michael; Schwartz, Matthijs P; Vogelaar, Lauran; de Vos Tot Nederveen Cappel, Wouter H; Seerden, Tom C J; Hazen, Wouter L; Schrauwen, Ruud W M; Alvarez Herrero, Lorenza; Schreuder, Ramon-Michel M; van Nunen, Annick B; Stoop, Esther; de Bruin, Gijs J; Bos, Philip; Marsman, Willem A; Kuiper, Edith; de Bièvre, Marc; Alderlieste, Yasser A; Roomer, Robert; Groen, John; Bargeman, Marloes; van Leerdam, Monique E; Roberts-Bos, Linda; Boersma, Femke; Thurnau, Karsten; de Vries, Roland S; Ramaker, Jos M; Vleggaar, Frank P; de Ridder, Rogier J; Pellisé, María; Bourke, Michael J; Masclee, Ad A M; Moons, Leon M G
(2024) Gut, volume 73, issue 5, pp. 741 - 750
(Article)
Abstract
Objective Endoscopic mucosal resection (EMR) is the preferred treatment for non-invasive large (≥20 mm) non-pedunculated colorectal polyps (LNPCPs) but is associated with an early recurrence rate of up to 30%. We evaluated whether standardised EMR training could reduce recurrence rates in Dutch community hospitals. Design In this multicentre cluster randomised
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trial, 59 endoscopists from 30 hospitals were randomly assigned to the intervention group (e-learning and 2-day training including hands-on session) or control group. From April 2019 to August 2021, all consecutive EMR-treated LNPCPs were included. Primary endpoint was recurrence rate after 6 months. Results A total of 1412 LNPCPs were included; 699 in the intervention group and 713 in the control group (median size 30 mm vs 30 mm, 45% vs 52% size, morphology, site and access (SMSA) score IV, 64% vs 64% proximal location). Recurrence rates were lower in the intervention group compared with controls (13% vs 25%, OR 0.43; 95% CI 0.23 to 0.78; p=0.005) with similar complication rates (8% vs 9%, OR 0.93; 95% CI 0.64 to 1.36; p=0.720). Recurrences were more often unifocal in the intervention group (92% vs 76%; p=0.006). In sensitivity analysis, the benefit of the intervention on recurrence rate was only observed in the 20-40 mm LNPCPs (5% vs 20% in 20-29 mm, p=0.001; 10% vs 21% in 30-39 mm, p=0.013) but less evident in ≥40 mm LNPCPs (24% vs 31%; p=0.151). In a post hoc analysis, the training effect was maintained in the study group, while in the control group the recurrence rate remained high. Conclusion A compact standardised EMR training for LNPCPs significantly reduced recurrences in community hospitals. This strongly argues for a national dedicated training programme for endoscopists performing EMR of ≥20 mm LNPCPs. Interestingly, in sensitivity analysis, this benefit was limited for LNPCPs ≥40 mm. Trial registration number NTR7477.
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Keywords: COLORECTAL ADENOMAS, COLORECTAL NEOPLASIA, ENDOSCOPIC POLYPECTOMY, ENDOSCOPIC PROCEDURES, THERAPEUTIC ENDOSCOPY, Gastroenterology, Journal Article
ISSN: 0017-5749
Publisher: BMJ Publishing Group
Note: Publisher Copyright: © Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.
(Peer reviewed)