Endoscopic mucosal resection (EMR) versus endoscopic submucosal dissection (ESD) for resection of large distal non-pedunculated colorectal adenomas (MATILDA-trial): rationale and design of a multicenter randomized clinical trial. Issue 1 (December 2016)

• Record Type: Journal Article
• Authors: Backes, Y.; Moons, L.; van Bergeijk, J.; Berk, L.; ter Borg, F.; ter Borg, P.; Elias, S.; Geesing, J.; Groen, J.; Hadithi, M.; Hardwick, J.; Kerkhof, M.; Mangen, M.; Straathof, J.; Schröder, R.; Schwartz, M.; Spanier, B.; de Vos tot Nederveen Cappel, W.; Wolfhagen, F.; Koch, A.
• Is Part Of: BMC gastroenterology. Volume 16:Issue 1(2016)
• Page Start: 1
• Page End: 10
• Publication Date: 2016-12
• Subjects: Colorectal adenoma -- Endoscopic mucosal resection -- Endoscopic submucosal dissection -- Randomized clinical trial -- Colonoscopy; Gastroenterology -- Periodicals; Gastrointestinal Diseases -- Periodicals; Biliary Tract Diseases -- Periodicals; Molecular Biology -- Periodicals; Liver Diseases -- Periodicals; 616.33005
• DOI: 10.1186/s12876-016-0468-6
• Languages: English
• ISSNs: 1471-230X

Abstract

Abstract Background Endoscopic mucosal resection (EMR) is currently the most used technique for resection of large distal colorectal polyps. However, in large lesions EMR can often only be performed in a piecemeal fashion resulting in relatively low radical (R0)-resection rates and high recurrence rates. Endoscopic submucosal dissection (ESD) is a newer procedure that is more difficult resulting in a longer procedural time, but is promising due to the high en-bloc resection rates and the very low recurrence rates. We aim to evaluate the (cost-)effectiveness of ESD against EMR on both short (i.e. 6 months) and long-term (i.e. 36 months). We hypothesize that in the short-run ESD is more time consuming resulting in higher healthcare costs, but is (cost-) effective on the long-term due to lower patients burden, a higher number of R0-resections and lower recurrence rates with less need for repeated procedures. Methods This is a multicenter randomized clinical trial in patients with a non-pedunculated polyp larger than 20 mm in the rectum, sigmoid, or descending colon suspected to be an adenoma by means of endoscopic assessment. Primary endpoint is recurrence rate at follow-up colonoscopy at 6 months. Secondary endpoints are R0-resection rate, perceived burden and quality of life, healthcare resources utilization and costs, surgical referral rate, complication rate and recurrence rate at 36 months. Quality-adjusted-life-year (QALY) will be estimated taking an area under the curve approach and using EQ-5D-indexes. Healthcare costs will be calculated by multiplying used healthcare services with unit prices. The cost-effectiveness of ESD against EMR will be expressed as incremental cost-effectiveness ratios (ICER) showing additional costs per recurrence free patient and as ICER showing additional costs per QALY. Discussion If this trial confirms ESD to be favorable on the long-term, the burden of extra colonoscopies and repeated procedures can be prevented for future patients. Trial registration NCT02657044 (Clinicaltrials.gov), registered January 8, 2016.