{"doi":"10.7326/m23-1812","title":"Endoscopic En Bloc Versus Piecemeal Resection of Large Nonpedunculated Colonic Adenomas","abstract":null,"journal":"Annals of Internal Medicine","year":2024,"id":620415,"datarank":0.7346759699926367,"base_score":4.897839799950911,"endowment":4.897839799950911,"self_citation_contribution":0.7346759699926367,"citation_network_contribution":0.0,"self_endowment_contribution":0.7346759699926367,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":133,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1601604,"name":"Marion Schaefer","orcid":"0000-0002-5002-0486","position":1,"is_corresponding":false},{"id":1601606,"name":"Timothée Wallenhorst","orcid":null,"position":2,"is_corresponding":false},{"id":422059,"name":"Thomas Rösch","orcid":"0000-0003-2270-2495","position":3,"is_corresponding":false},{"id":1601608,"name":"Vincent Lépilliez","orcid":"0000-0003-4868-7924","position":4,"is_corresponding":false},{"id":1601610,"name":"Stanislas Chaussade","orcid":null,"position":5,"is_corresponding":false},{"id":1601612,"name":"Jérôme Rivory","orcid":null,"position":6,"is_corresponding":false},{"id":1601614,"name":"Romain Legros","orcid":null,"position":7,"is_corresponding":false},{"id":1601615,"name":"Jean-Baptiste Chevaux","orcid":null,"position":8,"is_corresponding":false},{"id":1382480,"name":"Sarah Leblanc","orcid":null,"position":9,"is_corresponding":false},{"id":1601616,"name":"Florian Rostain","orcid":null,"position":10,"is_corresponding":false},{"id":1601617,"name":"Maximilien Barret","orcid":"0000-0002-0566-7870","position":11,"is_corresponding":false},{"id":1601619,"name":"Jérémie Albouys","orcid":null,"position":12,"is_corresponding":false},{"id":1601620,"name":"Arthur Belle","orcid":null,"position":13,"is_corresponding":false},{"id":1601622,"name":"Anaïs Labrunie","orcid":"0000-0002-7800-8331","position":14,"is_corresponding":false},{"id":1601623,"name":"Pierre-Marie Preux","orcid":null,"position":15,"is_corresponding":false},{"id":1601624,"name":"Hugo Lepetit","orcid":null,"position":16,"is_corresponding":false},{"id":1601625,"name":"Martin Dahan","orcid":null,"position":17,"is_corresponding":false},{"id":1601626,"name":"Thierry Ponchon","orcid":null,"position":18,"is_corresponding":false},{"id":1601627,"name":"Sabrina Crépin","orcid":"0000-0001-5316-391X","position":19,"is_corresponding":false},{"id":1601628,"name":"Loïc Marais","orcid":null,"position":20,"is_corresponding":false},{"id":1601629,"name":"Julien Magne","orcid":"0000-0001-7598-8234","position":21,"is_corresponding":false},{"id":1601630,"name":"Mathieu Pioche","orcid":null,"position":22,"is_corresponding":false},{"id":1601603,"name":"Jérémie Jacques","orcid":null,"position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Endoscopic En Bloc Versus Piecemeal Resection of Large Nonpedunculated Colonic Adenomas","abstract":"BACKGROUND: Endoscopic resection of adenomas prevents colorectal cancer, but the optimal technique for larger lesions is controversial. Piecemeal endoscopic mucosal resection (EMR) has a low adverse event (AE) rate but a variable recurrence rate necessitating early follow-up. Endoscopic submucosal dissection (ESD) can reduce recurrence but may increase AEs. OBJECTIVE: To compare ESD and EMR for large colonic adenomas. DESIGN: Participant-masked, parallel-group, superiority, randomized controlled trial. (ClinicalTrials.gov: NCT03962868). SETTING: Multicenter study involving 6 French referral centers from November 2019 to February 2021. PARTICIPANTS: Patients with large (≥25 mm) benign colonic lesions referred for resection. INTERVENTION: The patients were randomly assigned by computer 1:1 (stratification by lesion location and center) to ESD or EMR. MEASUREMENTS: The primary end point was 6-month local recurrence (neoplastic tissue on endoscopic assessment and scar biopsy). The secondary end points were technical failure, en bloc R0 resection, and cumulative AEs. RESULTS: = 318 lesions in 318 patients), recurrence occurred after 1 of 161 ESDs (0.6%) and 8 of 157 EMRs (5.1%) (relative risk, 0.12 [95% CI, 0.01 to 0.96]). No recurrence occurred in R0-resected cases (90%) after ESD. The AEs occurred more often after ESD than EMR (35.6% vs. 24.5%, respectively; relative risk, 1.4 [CI, 1.0 to 2.0]). LIMITATION: Procedures were performed under general anesthesia during hospitalization in accordance with the French health system. CONCLUSION: Compared with EMR, ESD reduces the 6-month recurrence rate, obviating the need for systematic early follow-up colonoscopy at the cost of more AEs. 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