Thermal treatment of the margin after piecemeal endoscopic mucosal resection (EMR) of laterally spreading lesions (LSLs) ≥20 mm is now considered standard of care because it lowers the recurrence rate, which has been a longstanding concern about the use of piecemeal EMR. Meta-analyses have shown that thermal margin treatment reduces recurrence rates by 75% to 80%.
In a retrospective analysis of a prospectively collected database of LSLs, the impact of margin treatment on lesions ≥40 mm was evaluated. The study excluded lesions smaller than 40 mm, not followed up at the study center, or in which argon plasma coagulation was used for either margin treatment or ablation of residual polyp. Propensity score analysis was used to account for differences between patients in treated versus nontreated groups.
There were 68 lesions ≥40 mm removed without snare tip soft coagulation (STSC) treatment and 133 removed with STSC. The recurrence rates were 9% with STSC and 35% without STSC (P<.00001 by direct comparison and P=.008 using propensity score analysis).
Nader SM, Lahr RE, Rex DK. Impact of margin thermal treatment after endoscopic mucosal resection of giant (≥ 40 mm) colorectal lateral spreading lesions. Gastrointest Endosc
2022 Oct 25. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2022.10.032