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The following is a summary of “Endoscopic mucosal resection versus surgery for colon adenomas and early-stage cancers: a comparative effectiveness study,” published in the April 2025 issue of the Gastrointestinal Endoscopy by Kwok et al.
Endoscopic mucosal resection (EMR) is widely recognized as the standard of care for appropriate colonic lesions. However, its comparative performance regarding long-term medical and healthcare utilization outcomes within a broad, community-based United States population has not been fully characterized. This study sought to evaluate and compare all-cause mortality, recurrence rates, and healthcare utilization between patients undergoing colon EMR and those receiving surgical management.
This retrospective cohort study analyzed patients treated between 2008 and 2017. Eligible individuals who underwent colon EMR were compared to those who underwent surgical resection. The primary endpoint was all-cause mortality, while secondary outcomes included lesion recurrence and various measures of healthcare resource utilization. Data analysis was performed using HR and 95% CI, with statistical significance set at p < 0.05.
A total of 568 patients were included in the EMR group, and 2,054 patients were assigned to the surgical group. The mean follow-up period across both cohorts was 4.5 years. Analysis demonstrated that patients treated with EMR had significantly lower all-cause mortality compared to those who underwent surgery (HR = 0.31; 95% CI, 0.19–0.495; p < 0.0001). Furthermore, EMR was associated with substantially reduced healthcare utilization across all categories examined, including hospitalizations, procedural interventions, and outpatient visits (all p < 0.0001).
These findings suggest that, in a real-world, community-based practice setting, EMR is associated with superior survival outcomes and reduced healthcare resource demands compared to surgical intervention for eligible colonic lesions. This highlights the importance of adopting EMR as a first-line therapeutic approach whenever feasible and supports its broader application outside of tertiary care centers.
Further prospective research could help confirm these findings and explore additional strategies to optimize EMR outcomes, particularly in community settings where resource availability and expertise may vary.
Source: giejournal.org/article/S0016-5107(25)01624-4/abstract
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