Douglas K. Rex, MD reviewing Tate DJ et al. Gastrointest Endosc 2016 Nov 28.

The SERT tool identifies a low-risk group who could possibly forgo the standard 6-month follow-up.

The Sydney EMR Recurrence Tool (SERT) is a prediction model for recurrence at follow-up after endoscopic mucosal resection (EMR) of large, lateral-spreading tumors. To develop the tool, researchers prospectively assessed 1178 lesions ≥20 mm in size at piecemeal EMR and first follow-up colonoscopy.

The overall rate of endoscopically detectable recurrence was 19.4%. Visible endoscopic recurrence had a negative predictive value of 99.2% and a positive predictive value of 66.1% based on histologic determination. Predictors of endoscopic recurrence were size ≥40 mm (odds ratio, 2.47), intraprocedural bleeding (OR, 1.78), and high-grade dysplasia (OR, 1.72); these predictors contributed 2 points, 1 point, and 1 point, respectively, to the cumulative SERT score of 0–4 points.

The rates of recurrence at first follow-up for SERT scores of 0–4 were 8.7%, 17.5%, 26.0%, 27.4%, and 47.8%, respectively. The recurrence rate for scores 1–4 combined was 25.9%. For a SERT score of 0, cumulative risk for endoscopic recurrence at 6, 12, 18, and 36 months was 9.8%, 11.6%, 11.6%, and 16.6%, and recurrences were typically tiny, diminutive, and with low-grade dysplasia.

CITATION(S):

Tate DJ et al. Adenoma recurrence after piecemeal colonic EMR is predictable; the Sydney EMR Recurrence Tool. Gastrointest Endosc 2016 Nov 28; [e-pub].

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