Recurrence after piecemeal endoscopic mucosal resection (pEMR) of large colorectal lesions remains a significant clinical concern. Several lesion-related factors, including morphology, high-grade dysplasia (HGD), lesion size and use of snare-tip soft coagulation (STSC) have been proposed as potential predictors (1,2). 

We conducted a retrospective study including 84 consecutive patients undergoing piecemeal EMR for colorectal lesions ≥20 mm at an Italian non-tertiary centre. Demographic, endoscopic and histological variables were collected. Time-to-recurrence was assessed using Kaplan–Meier curves and the log-rank test. Independent predictors were evaluated using multivariate Cox regression (p < 0.05).

Eighty-four lesions were analysed. Recurrence was significantly higher in lesions with HGD (p = 0.00091) and in those ≥25 mm (p = 0.022). No significant differences were observed between lesions treated with STSC and those without STSC (p = 0.057), between granular and non-granular LSTs (p = 0.84), or between serrated and non-serrated lesions (p = 0.48). In multivariate Cox regression, HGD was the only independent predictor of recurrence (HR 3.5; 95% CI 1.19–10.5; p = 0.023). Lesion size ≥25 mm showed no statistically significant association with recurrence (HR 3.5; 95% CI 0.78–16.1; p = 0.102). STSC was also not independently associated with recurrence (HR 1.6; 95% CI 0.39–6.3; p = 0.522), a result likely reflecting its selective use in larger, higher-risk lesions.

High-grade dysplasia was the strongest predictor of recurrence. Lesion size and STSC were not independently associated with relapse. Interpretation of the effect of STSC is limited by the small number of treated cases and their concentration in higher-risk lesions.