Snare Tip Soft Coagulation Reduced Recurrence After EMR in Routine Practice

Colorectal

Douglas K. Rex, MD, MASGE reviewing Arisha MA, et al. Gastrointest Endosc 2022 Oct 31.

Thermal treatment of endoscopic mucosal resection (EMR) margin defects after complete resection of large (≥20 mm) nonpedunculated colorectal polyps has reduced the recurrence rate at first follow-up by 75% to 80% in randomized controlled trials and large observational studies performed by experts.

In a nonrandomized study of colorectal EMR in 3 hospitals in Israel, there were 824 large nonpedunculated colorectal polyps (LNPCPs) in 764 patients. Of the LNPCPs, 464 were treated with snare tip soft coagulation (STSC) and 360 were not. The recurrence rate at first surveillance was 3.6% with STSC and 31.6% without STSC (P<.001). When lesions on the ileocecal valve, appendix, those that were fully circumferential, and previously attempted lesions were included, the recurrence rate was 6.8% with STSC and 33.5% without (P<.001). In a multivariable analysis, thermal treatment of the margin after complete EMR was associated with an 86% reduction in recurrence.

Comment:

These data support that the STSC technique is easily reproducible, though the 9 endoscopists in the 3 centers in this study were local experts, as the patients were referred to them for resection. Despite that, we haven’t seen evidence indicating that the technique is difficult to learn or reproduce.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

Douglas K. Rex, MD, MASGE

Bio and Disclosures

Citation(s):

Arisha MA, Scapa E, Wishahi E, et al. Impact of margin ablation after endoscopic mucosal resection of large non pedunculated colonic polyps in routine clinical practice. Gastrointest Endosc 2022 Oct 31. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2022.10.036)