U.S. Colorectal EMR Rates Rising, Regional Variation

Douglas K. Rex, MD, FASGE reviewing Yu JX, et al. Gastrointest Endosc 2019 Aug 19.

Endoscopic mucosal resection (EMR) has emerged as the clear treatment of choice for nearly all benign colorectal lateral spreading tumors (LSTs). This report examined 1,716,374 colonoscopies performed in the U.S. in a 5-year period, beginning January 2011, and accessed through a single insurance plan covering commercial and Medicare Advantage patients. Injection and EMR codes were used to identify EMR.

Rates of colorectal EMR as a fraction of all colonoscopies increased from 1.62% to 2.48% during the interval. EMR use was higher in the West at 2.4% compared to 2.0% in the South, with the Northeast and Midwest at 2.3%. After EMR, rates of GI bleeding were 1.35%, perforation 0.22%, and hospital admission within 30 days for any reason 9.1%, all 3 to 4 times higher than the rates for simple polypectomy (as expected). Over the study interval, complication rates of EMR remained stable, but admission rates after EMR declined from 10.3% to 8.4% (p<0.001).


Comment:

The central public health issue regarding EMR is this: If EMR is the first-line treatment for benign colorectal LSTs, then why are rates of surgical resection for benign colon polyps increasing in the U.S.? This study does not provide insight into this question because rising rates of EMR could be occurring due to increased use for lesions that were previously removed without injection, and this could occur without a reduction in referral of lesions to surgery. Despite that, this study confirms that the absolute rates of serious events after EMR are considerably lower than those expected with surgery.

Note to readers:
At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

Douglas K. Rex, MD, FASGE
Bio and Disclosures

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Citation(s):
Yu JX, Lin JL, Oliver M, et al. Trends in endoscopic mucosal resection for nonmalignant colorectal polyps in the United States. Gastrointest Endosc 2019 Aug 19. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2019.08.004)