TY - JOUR
T1 - Standardised training for endoscopic mucosal resection of large non-pedunculated colorectal polyps to reduce recurrence (*STAR-LNPCP study)
T2 - a multicentre cluster randomised trial
AU - Meulen, Lonne W T
AU - Bogie, Roel M M
AU - Siersema, Peter D
AU - Winkens, Bjorn
AU - Vlug, Marije S
AU - Wolfhagen, Frank H J
AU - Baven-Pronk, Martine
AU - van der Voorn, Michael
AU - Schwartz, Matthijs P
AU - Vogelaar, Lauran
AU - de Vos Tot Nederveen Cappel, Wouter H
AU - Seerden, Tom C J
AU - Hazen, Wouter L
AU - Schrauwen, Ruud W M
AU - Alvarez Herrero, Lorenza
AU - Schreuder, Ramon-Michel M
AU - van Nunen, Annick B
AU - Stoop, Esther
AU - de Bruin, Gijs J
AU - Bos, Philip
AU - Marsman, Willem A
AU - Kuiper, Edith
AU - de Bièvre, Marc
AU - Alderlieste, Yasser A
AU - Roomer, Robert
AU - Groen, John
AU - Bargeman, Marloes
AU - van Leerdam, Monique E
AU - Roberts-Bos, Linda
AU - Boersma, Femke
AU - Thurnau, Karsten
AU - de Vries, Roland S
AU - Ramaker, Jos M
AU - Vleggaar, Frank P
AU - de Ridder, Rogier J
AU - Pellisé, María
AU - Bourke, Michael J
AU - Masclee, Ad A M
AU - Moons, Leon M G
PY - 2024/4/5
Y1 - 2024/4/5
N2 - 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 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.
AB - 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 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.
KW - COLORECTAL ADENOMAS
KW - COLORECTAL NEOPLASIA
KW - ENDOSCOPIC POLYPECTOMY
KW - ENDOSCOPIC PROCEDURES
KW - THERAPEUTIC ENDOSCOPY
U2 - 10.1136/gutjnl-2023-330020
DO - 10.1136/gutjnl-2023-330020
M3 - Article
SN - 0017-5749
VL - 73
SP - 741
EP - 750
JO - Gut
JF - Gut
IS - 5
ER -