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Meulen, Lonne W T; Bogie, Roel M M; Siersema, Peter D; Winkens, Bjorn; Vlug, Marije S; Wolfhagen, Frank H J; Baven-Pronk, Martine; van der Voorn, Michael; Schwartz, Matthijs P; Vogelaar, Lauran; de Vos tot Nederveen Cappel, Wouter H; Seerden, Tom C J; Hazen, Wouter L; Schrauwen, Ruud W M; Alvarez Herrero, Lorenza; Schreuder, Ramon-Michel M; van Nunen, Annick B; Stoop, Esther; de Bruin, Gijs J; Bos, Philip; Marsman, Willem A; Kuiper, Edith; de Bièvre, Marc; Alderlieste, Yasser A; [...]

Standardised training for endoscopic mucosal resection of large non-pedunculated colorectal polyps to reduce recurrence (*STAR-LNPCP study): a multicentre cluster randomised trial

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  • Media type: E-Article
  • Title: Standardised training for endoscopic mucosal resection of large non-pedunculated colorectal polyps to reduce recurrence (*STAR-LNPCP study): a multicentre cluster randomised trial
  • Contributor: Meulen, Lonne W T; Bogie, Roel M M; Siersema, Peter D; Winkens, Bjorn; Vlug, Marije S; Wolfhagen, Frank H J; Baven-Pronk, Martine; van der Voorn, Michael; Schwartz, Matthijs P; Vogelaar, Lauran; de Vos tot Nederveen Cappel, Wouter H; Seerden, Tom C J; Hazen, Wouter L; Schrauwen, Ruud W M; Alvarez Herrero, Lorenza; Schreuder, Ramon-Michel M; van Nunen, Annick B; Stoop, Esther; de Bruin, Gijs J; Bos, Philip; Marsman, Willem A; Kuiper, Edith; de Bièvre, Marc; Alderlieste, Yasser A; [...]
  • Published: BMJ, 2024
  • Published in: Gut (2024), Seite gutjnl-2023-330020
  • Language: English
  • DOI: 10.1136/gutjnl-2023-330020
  • ISSN: 0017-5749; 1468-3288
  • Keywords: Gastroenterology
  • Origination:
  • Footnote:
  • Description: <jats:sec><jats:title>Objective</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Trial registration number</jats:title><jats:p>NTR7477.</jats:p></jats:sec>