A novel tool for case selection in endoscopic mucosal resection training

Background As endoscopic mucosal resection ( EMR) of large (>= 20mm) adenomatous nonpedunculated colonic polyps (LNPCPs) becomes widely practiced outside expert centers, appropriate training is necessary to avoid failed resection and inappropriate surgical referral. No EMR-specific tool guides case selection for endoscopists learning EMR. This study aimed to develop an EMR case selection score (EMR-CSS) to identify potentially challenging lesions for EMR-naive endoscopists developing competency. Methods Consecutive EMRs were recruited from a single center over 130 months. Lesion characteristics, intraprocedural data, and adverse events were recorded. Challenging lesions with intraprocedural bleeding (IPB), intraprocedural perforation ( IPP), or unsuccessful resection were identified and predictive variables identified. Significant variables were used to form a numerical score and receiver operating characteristic curves were used to generate cutoff values. Results Of 1993 LNPCPs, 286 (14.4%) were in challenging locations (anorectal junction, ileocecal valve, or appendiceal orifice), 368 ( 18.5%) procedures were complicated by IPB and 77 (3.9 %) by IPP; 110 ( 5.5 %) procedures were unsuccessful. The composite end point of IPB, IPP, or unsuccessful EMR was present in 526 cases (26.4 %). Lesion size, challenging location, and sessile morphology were predictive of the composite outcome. A six-point score was generated with a cutoff value of 2 demonstrating 81% sensitivity across the training and validation cohorts. Conclusions The EMR- CSS is a novel case selection tool for conventional EMR training, which identifies a subset of adenomatous LNPCPs that can be successfully and safely attempted in early EMR training.

Automated summary

The study aimed to develop an EMR Case Selection Score (EMR-CSS) to help inexperienced endoscopists choose appropriate cases for EMR training. The results showed that lesion size, location, and morphology predicted the success of EMR. A six-point score with a cutoff value of 2 demonstrated 81% sensitivity in both the training and validation cohorts.