Systematic Description of the Post EMR Defect
Systematic Description of the Post EMR Defect
To date there are no available data on the utility of the endoscopic mucosal resection (EMR)
 defect in stratifying the risk of immediate or delayed adverse outcomes, particularly
 clinically significant post EMR bleeding (CSPEB).

 The investigators aimed to analyse the data to determine if any of these EMR defect features
 allow us to estimate the risk of CSPEB. This will help endoscopists to identify defects with
 a high risk of adverse outcomes and may translate into improved patient outcomes.
CSPEB is the most frequent serious complication after wide-field EMR of laterally spreading
 lesions ≥ 20mm (LSLs). There is no proven therapy for CSPEB and it remains a significant
 drawback of EMR. Visible vessels within the post EMR defect (PED) present themselves as
 logical targets for prophylactic treatment to prevent CSPEB. However, the clinical
 significance of these vessels is largely unknown. In the majority of studies risk factors
 identified for CSPEB include right colon location, lesion size and aspirin use. The
 investigators aimed to systematically describe and evaluate the clinical significance of the
 various endoscopic features of the post EMR defect PED including visible vessels.

 A prospective study of LSLs ≥ 20mm referred for EMR at a single tertiary referral center will
 be performed.

 Data collection includes patient, procedural and lesion characteristics. In all cases a
 systematic description of the PED is undertaken. The data of particular interest to this
 study includes: use of blood thinners, PED features including size, number and herniation of
 visible vessels, submucosal haemorrhage, fibrosis, fat and exposed muscle and the rate of
 CSPEB.These features were analysed for significant association with CSPEB. CSPEB was defined
 as any bleeding occurring after the completion of the procedure necessitating emergency
 department presentation, hospitalization or reintervention. CSPEB was compared to features of
 the PED to detect significant associations, using chi2 or Fisher's exact tests. Significant
 univariate variables will be taken forward for binomial logistic regression modelling.
Inclusion Criteria:

 -  All patients referred for EMR of a LSL 20mm or larger

 -  Signed the informed consent

 Exclusion Criteria:

 -  Clips used during the EMR procedure to close the defect, totally or partially

 -  Inadequate images to adequately assess the defect

 -  Use of blood thinners which have not been ceased according to the current guidelines
 for EMR