{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T03:57:09Z","timestamp":1769572629830,"version":"3.49.0"},"reference-count":16,"publisher":"S. Karger AG","issue":"4","license":[{"start":{"date-parts":[[2021,9,6]],"date-time":"2021-09-06T00:00:00Z","timestamp":1630886400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2021,9,6]],"date-time":"2021-09-06T00:00:00Z","timestamp":1630886400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["GE Port J Gastroenterol"],"published-print":{"date-parts":[[2022]]},"abstract":"<b><i>Introduction:<\/i><\/b> Endoscopic mucosal resection (EMR) is the treatment of choice for non-invasive colorectal flat lesions. When endoscopic piecemeal mucosal resection (EPMR) is performed, endoscopic surveillance is necessary due to the risk of recurrence. The Sydney EMR Recurrence Tool (SERT) is a 0\u20134 scale that classifies lesions according to size, occurrence of intraprocedural bleeding (IPB) and presence of high-grade dysplasia (HGD). Our goal is to evaluate the applicability of SERT in predicting adenoma recurrence (AR) after EPMR. <b><i>Methods:<\/i><\/b> This is a retrospective single-centre study with inclusion of lateral spreading lesions \u226520 mm, consecutively resected by EPMR from March 2010 to February 2018, with at least 1 endoscopic re-evaluation. <b><i>Results:<\/i><\/b> A total of 181 lesions were included, corresponding to 174 patients with a mean age of 68 years and male gender predominance (61%; <i>n<\/i> = 106). The most frequent location was the ascending colon (34%; <i>n<\/i> = 62). Lesions were assessed according to Paris Classification (PC): 0-IIa: 39% (<i>n<\/i> = 71); 0-IIb: 24% (<i>n<\/i> = 43); 0-IIa + Is: 23% (<i>n<\/i> = 42); 0-IIa + IIb: 6% (<i>n<\/i> = 11); 0-IIa + IIc: 2% (<i>n<\/i> = 3). The mean size of the lesions was 33 \u00b1 11 mm, with 25 (14%) being \u226540 mm. IPB occurred in 9 cases (5%), and 44 lesions (24%) displayed HGD. Sixty-six lesions (36.5%) were classified as SMSA (size, morphology, site, and access score) level 4. Adjunctive therapy with argon plasma coagulation (APC) was used in 37% (<i>n<\/i> = 67) of cases. The 6-month AR rate was 16% (<i>n<\/i> = 29). According to SERT groups, the AR rate was: SERT 0: 12% (14\/120); SERT 1: 17% (6\/35); SERT 2: 25% (3\/12); SERT 3: 30% (3\/10); SERT 4: 75% (3\/4). Two of the three SERT variables (size \u226540 mm and IPB) were associated with recurrence at 6 months (<i>p<\/i> &#x3c; 0.05). HGD and the remaining tested variables (age, gender, localization, accessibility, PC, use of APC\/biopsy forceps and occurrence of delayed bleeding) were not associated with AR. SERT 0 lesions showed an inferior risk of 6-month AR (adjusted OR = 2.62; <i>p<\/i> = 0.035), with a negative predictive value of 88%. SMSA correlated with SERT (<i>p<\/i> &#x3c; 0.001) and SMSA level 4 was associated with 6-month AR (<i>p<\/i> = 0.007). Lesions classified both as SERT 0 and SMSA level &#x3c;4 had the lowest 6-month recurrence rate (9.2%). The 24-month recurrence rate was 23% (<i>n<\/i> = 41). When applying the Kaplan-Meier method, cumulative recurrence was significantly lower in SERT 0 lesions (<i>p<\/i> = 0.006, log-rank test). <b><i>Discussion\/Conclusion:<\/i><\/b> Resection of flat colorectal lesions by EPMR has a considerable risk of recurrence, mostly in SERT 1\u20134 lesions. SERT 0 lesions, especially with SMSA level &#x3c;4, show a lower risk of recurrent adenoma, which might allow longer intervals to first endoscopic surveillance in the future. <\/jats:p>","DOI":"10.1159\/000518445","type":"journal-article","created":{"date-parts":[[2021,9,6]],"date-time":"2021-09-06T21:01:37Z","timestamp":1630962097000},"page":"247-255","source":"Crossref","is-referenced-by-count":2,"title":["Adenoma Recurrence after Endoscopic Piecemeal Mucosal Resection of Colorectal Flat Lesions: Applicability of the Sydney EMR Recurrence Tool in a Non-Tertiary Centre"],"prefix":"10.1159","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5545-868X","authenticated-orcid":false,"given":"Maria\u00a0Azevedo","family":"Silva","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9030-0645","authenticated-orcid":false,"given":"Carina","family":"Leal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andr\u00e9","family":"Ruge","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra","family":"Fernandes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liliana","family":"Eliseu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helena","family":"Vasconcelos","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"127","published-online":{"date-parts":[[2021,9,6]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0043-102569"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2015.08.037"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1016\/j.critrevonc.2016.06.008"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2014.04.015"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1055\/s-0034-1364970"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.4253\/wjge.v8.i5.276"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2013-305516"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2016.11.027"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1055\/s-0043-122070"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1136\/flgastro-2013-100331"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0b013e31829193e0"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1055\/a-1185-3109"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.5217\/ir.2017.15.4.502"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2012.02.060"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1080\/00365521.2020.1749296"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2016.06.031"}],"container-title":["GE - Portuguese Journal of Gastroenterology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.karger.com\/Article\/Pdf\/518445","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.karger.com\/Article\/Pdf\/518445","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T15:15:54Z","timestamp":1745421354000},"score":1,"resource":{"primary":{"URL":"https:\/\/karger.com\/article\/doi\/10.1159\/000518445"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,6]]},"references-count":16,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,7,1]]},"published-print":{"date-parts":[[2022,6,30]]}},"URL":"https:\/\/doi.org\/10.1159\/000518445","archive":["Portico"],"relation":{},"ISSN":["2341-4545","2387-1954"],"issn-type":[{"value":"2341-4545","type":"print"},{"value":"2387-1954","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,6]]}}}