SNFGE SNFGE
 
Thématique :
- Endoscopie/Imagerie
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Docteur Vincent VALANTIN
Coup de coeur :
 
 
Endoscopy
  2018/07  
 
  2018 Jul;50(7):684-692.  
  doi: 10.1055/s-0043-124081.  
 
  The size, morphology, site, and access score predicts critical outcomes of endoscopic mucosal resection in the colon.  
 
  Sidhu M, Tate DJ, Desomer L, Brown G, Hourigan LF, Lee EYT, Moss A, Raftopoulos S, Singh R, Williams SJ, Zanati S, Burgess N, Bourke MJ  
  https://www.ncbi.nlm.nih.gov/pubmed/29370584  
 
 

Abstract

BACKGROUND:

 The SMSA (size, morphology, site, access) polyp scoring system is a method of stratifying the difficulty of polypectomy through assessment of four domains. The aim of this study was to evaluate the ability of SMSA to predict critical outcomes of endoscopic mucosal resection (EMR).

METHODS:

 We retrospectively applied SMSA to a prospectively collected multicenter database of large colonic laterally spreading lesions (LSLs) ≥ 20 mm referred for EMR. Standard inject-and-resect EMR procedures were performed. The primary end points were correlation of SMSA level with technical success, adverse events, and endoscopic recurrence.

RESULTS:

 2675 lesions in 2675 patients (52.6 % male) underwent EMR. Failed single-session EMR occurred in 124 LSLs (4.6 %) and was predicted by the SMSA score (P < 0.001). Intraprocedural and clinically significant postendoscopic bleeding was significantly less common for SMSA 2 LSLs (odds ratio [OR] 0.36, P < 0.001 and OR 0.23, P < 0.01) and SMSA 3 LSLs (OR 0.41, P  < 0.001 and OR 0.60, P = 0.05) compared with SMSA 4 lesions. Similarly, endoscopic recurrence at first surveillance was less likely among SMSA 2 (OR 0.19, P < 0.001) and SMSA 3 (OR 0.33, P < 0.001) lesions compared with SMSA 4 lesions. This also extended to second surveillance among SMSA 4 LSLs.

CONCLUSION:

 SMSA is a simple, readily applicable, clinical score that identifies a subgroup of patients who are at increased risk of failed EMR, adverse events, and adenoma recurrence at surveillance colonoscopy. This information may be useful for improving informed consent, planning endoscopy lists, and developing quality control measures for practitioners of EMR, with potential implications for EMR benchmarking and training.

 

 
Question posée
 
Le score SMSA (4 niveaux de 1 à 4) intégrant la taille, la morphologie, l’accès et la situation des polypes LST est-il un facteur pronostic de la mucosectomie ?
 
Question posée
 
Les complications per et post endoscopie (saignement) et la récidive locale lors de la surveillance sont bien corrélées. D’autant plus basses que le score est bas.
 
Commentaires

Score clinico-endoscopique facile à réaliser, rapide, qui devrait faire ressortir un sous-groupe (SMSA 4) où les complications hémorragiques et la récidive sont plus fréquentes, ce qui pourrait modifier leur prise en charge, et ce dès les informations du consentement éclairé.

 
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