Delays in definitive endoscopic resection of previously manipulated colorectal polyps as a risk factor for inferior resection outcomes.

BACKGROUND & AIMS:Manipulation of colorectal polyps by biopsy, incomplete resection or tattoo placement under the lesion has been shown to cause submucosal fibrosis and associated inferior outcomes. The effect of delays between index manipulation and definitive resection on the incidence of fibrosis is unknown. METHODS:Patients undergoing endoscopic mucosal resection (EMR) of previously manipulated colorectal polyps ≥ 10 mm between 2016 and 2021 at a tertiary referral center were included. Time from index manipulation to definitive resection and the presence of fibrosis were noted. The effects of fibrosis on EMR outcomes were assessed. RESULTS:Among 221 previously manipulated lesions [180 biopsy, 23 incomplete/failed resection, 1 tattoo under lesion, 17 multiple types of manipulation], 51 (23%) demonstrated fibrosis. Fibrotic lesions were found to have been resected significantly later compared to non-fibrotic lesions (76 vs. 61 days, p=0.014). In a multivariate analysis controlling for other predictors of fibrosis, each 2-week delay was associated a 14% increase in the odds of fibrosis. Fibrotic lesions had inferior outcomes with a lower en-bloc resection rate (8% vs. 24%, p=0.014) and longer procedure time (71 vs. 52 minutes, p=<0.001). Adverse event and recurrence rates were comparable between groups. CONCLUSIONS:Delays in definitive resection of previously manipulated polyps are associated with an increased incidence of fibrosis with time and associated inferior outcomes. Manipulation should be discouraged, and if it occurs, prompt referral and scheduling for definitive resection should be prioritized.