Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/102938
Citations
Scopus Web of Science® Altmetric
?
?
Type: Journal article
Title: Actual endoscopic versus predicted surgical mortality for treatment of advanced mucosal neoplasia of the colon
Author: Ahlenstiel, G.
Hourigan, L.
Brown, G.
Zanati, S.
Williams, S.
Singh, R.
Moss, A.
Sonson, R.
Bourke, M.
Australian Colonic Endoscopic Mucosal Resection (ACE) Study Group
Citation: Gastrointestinal Endoscopy, 2014; 80(4):668-676
Publisher: Elsevier
Issue Date: 2014
ISSN: 0016-5107
1097-6779
Statement of
Responsibility: 
Golo Ahlenstiel, Luke F. Hourigan, Gregor Brown, Simon Zanati, Stephen J. Williams, Rajvinder Singh, Alan Moss, Rebecca Sonson, Michael J. Bourke, The Australian Colonic Endoscopic Mucosal Resection, ACE, Study Group
Abstract: Background: EMR of advanced mucosal neoplasia (AMN) (ie, sessile or laterally spreading lesions of R20 mm) of the colon has become an increasingly popular alternative to surgical resection. However, data regarding safety and mortality of EMR in comparison to surgery are limited. Objective: To compare actual endoscopic with predicted surgical mortality. Design: Prospective, observational, multicenter cohort study. Setting: Academic, high-volume, tertiary-care referral center. Patients: Consecutive patients referred for EMR. Intervention: EMR. Main Outcome Measurements: To predict hypothetical surgical mortality, the Association of Coloproctology of Great Britain and Ireland score, composed of physiological and surgical components, was calculated for each patient. Predicted surgical mortality was then compared with actual outcomes of EMR. The results were validated by an unselected subcohort by using the Colorectal Physiologic and Operative Severity Score for Enumeration of Mortality and Morbidity. Results: Among 1050 patients with AMN treated by EMR, including patients with a predicted mortality rate of greater than 5% (13.8% of cohort), no deaths occurred within 30 days after the procedure. The predicted surgical mortality rate was 3.3% with the Association of Coloproctology of Great Britain and Ireland score (P!.0001). This suggests a significant advantage of EMR over surgery. The results were validated by using the Colorectal Physiologic and Operative Severity Score for Enumeration of Mortality and Morbidity in 390 patients predicting a surgical mortality rate of 3.2% (P Z .0003). Limitations: Nonrandomized study. Conclusion: In this large multicenter study of EMR for colonic AMN, the predicted surgical mortality rate was significantly higher than the actual endoscopic mortality rate. Given that endoscopic therapy is less morbid and less expensive than surgery and can be performed as an outpatient treatment, it should be considered as the first line of treatment for most patients with these lesions. (Gastrointest Endosc 2014;80:668-76.)
Keywords: Australian Colonic Endoscopic Mucosal Resection (ACE) Study Group; Intestinal Mucosa; Humans; Colonic Neoplasms; Neoplasm Invasiveness; Colonoscopy; Neoplasm Staging; Disease-Free Survival; Cause of Death; Risk Assessment; Survival Analysis; Cohort Studies; Prospective Studies; Predictive Value of Tests; Education, Medical, Continuing; Adult; Aged; Aged, 80 and over; Middle Aged; Australia; Female; Male
Rights: Copyright © 2014 by the American Society for Gastrointestinal Endoscopy
RMID: 0030049415
DOI: 10.1016/j.gie.2014.04.015
Appears in Collections:Medicine publications

Files in This Item:
There are no files associated with this item.


Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.