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Fjerning av store polypper - en meta-analyse Michael Bretthauer Professor, overlege Avdeling for Helseledelse og Helseøkonomi, UiO Avdeling for Transplantasjonsmedisin,

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Presentasjon om: "Fjerning av store polypper - en meta-analyse Michael Bretthauer Professor, overlege Avdeling for Helseledelse og Helseøkonomi, UiO Avdeling for Transplantasjonsmedisin,"— Utskrift av presentasjonen:

1 Fjerning av store polypper - en meta-analyse Michael Bretthauer Professor, overlege Avdeling for Helseledelse og Helseøkonomi, UiO Avdeling for Transplantasjonsmedisin, OUS (gastrolab) Harvard School of Public Health Sørlandet Sykehus

2 Clinical Effectiveness Research Group saker/ saker/

3 Gastroenterology 2013

4 Polypp i rectum 57 år gml kvinne 15mm TA m/grov dysplasi, biopsert ved screening Ingen flere lesjoner ved koloskopi 2x polypectomi forsøk henvist til laser behandling, men polyp ikke funnet 3. forsøk: EMR, uten problemer histologi: TA med grov dysplasi, komplett fjernet

5 58 yr old woman Biopsy of 2mm polyp 10cm from anal verge: TA w/severe dysplasia After 1 week: Biopsy of 2mm polyp 7cm from anal verge: Mucosal tag (no adenoma) After one year: Polypectomy of 3mm polyp w/ a speck of blood (photo) 10cm from anal verge: TA w/severe dysplasia M.Bretthauer 2001

6 Hva er dette Kvinne, født i 1950 Deltager i NORCCAP Ingen GI plager Ca mamma op 8 år siden screening sigmoidoskopi 10 cm fra anus

7 Cøkum

8 Cøkum NBI

9 Cøkum (SSA/P 4-5 cm)

10 Cøkum

11 Ascendens

12

13

14 Proksimale transversum (3-4 cm)

15 GUT 2011

16 Fjerning av store polypper - en meta-analyse

17 Background and General aim Efficacy and safety of endoscopic resection for large polypoid and non-polypoid lesions –Most of the series included only a relatively small –Low prevalence –Heterogeneity of results and techniques Pedunculated/sessile EMR/ESD Primary/secondary/tertiary centres Different countries

18 Specific aims Meta-analysis Rates of surgery for non-curative resection Adverse events (bleeding and perforation) Rates of –complete endoscopic resection –invasive cancer –mortality –polyp recurrence at follow-up –invasive cancer at follow-up –successful endoscopic treatment of recurrence –impact of ESD on surgery for non-curative resection/recurrence

19 Included studies All clinical studies 1966 to April 2014 ≥20 mm colorectal neoplastic lesions treated with endoscopic resection

20 Study Flowchart

21 Studies characteristics 76% of studies performed in the West, remaining in Asia Eight (16%) published 1977– (22%) 2000 and (62%) after 2007 Median f-up: 5 years (range: 1–21) 82% single centre Majority (58%) retrospective Median 89 patients/study (range )

22 Patients and polyps 50 studies 6442 patients Median age 67 years 54% males 6779 polyps Median diameter 33 mm (range: 20–51) 91% non-pedunculated (sessile or non- polypoid) 47% in the proximal colon

23 Polypectomy techniques EMR 56% Polypectomy 26% ESD 18% Piecemeal 62% En bloc 38%

24 Results

25 Rates of surgery

26 Rates of surgery for non-curative resection

27 Rates of surgery for adverse events

28 Risk factors for recurrence (surgery) Workload (threshold 29/year) Patient age (threshold 67 years)

29 Cancer/death after polypectomy 14 CRC (0.3%) 5 deaths (0.08%)

30

31 1.Follow up at 3-6 months and 1 year 2.Identification of scar 3.Biopsy 4.Retreat until no recurrence 5.Consider tertiary centre/surgery after tx failure Post-ER endoscopic surveillance strategy Suggestion

32


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