Short summary

Endoscopic mucosal resection (EMR) and Endoscopic sub mucosal dissection (ESD) is developed as a minimal invasive, organ sparing endoscopic resection of benign and former malign lesions in the gastrointestinal tract. EMR is an endoscopic technique, designed to resection of sessile, flat neoplasm's limited to the superficial layers (mucosa and sub mucosa). Typically this technique is uses on lesions <2 cm or on  piece meals of larger lesions. EMR and ESD is assumed to be efficient for definitive treatment of pre-malign and premature (T1mN0) malign lesions. The use of endoscopic ultrasound for staging before endoscopic resection, insures, that the tumor does not involve deeper layers or lymph nodes.

Rationale

The aim of this project is to evaluate the below mentioned conditions for patients with large sessile polyps in colon and rectum.

• Linkage between adenoma (polyp) size, histology and relapse frequency
• Complication frequency following EMR technique
• The value of endoscopic ultrasound for staging a tumor before endoscopic resection
• Ultrasound guided EMR as a definitive treatment modality for T1mN0 lesions

The evaluation will be done through routine application of the EMR technique for resection of large sessile adenomas, preceded by ultrasound. The overall hypothesis is that we, on the basis of a cohort of patients selected for EMR, can identify the potential premature cancers. If we wish to reduce the occurrence of malignancy the answer is an early identification of the adenoma which has the malign potential.

Description of the cohort

All patients who receive the EMR treatment at OUH Odense and Svendborg will be registered in the database. The plan is to expand the registration to include the whole Region of Southern Denmark and eventually all the regions in Denmark.

Data and biological material

All the data is clinical and is noted partly during the procedure and partly during the following arthroscopy. Pathological answers are also collected.

Collaborating researchers and departments

Department of Surgical Gastroenterology, Odense University Hospital, Svendborg and Odense

• Clinical Associate Professor Rozy Eckardt, MD, PhD