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Impact of margin thermal treatment after endoscopic mucosal resection of giant (≥ 40 mm) colorectal lateral spreading lesions

Published:October 24, 2022DOI:https://doi.org/10.1016/j.gie.2022.10.032
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      Abstract

      Background

      Increasing lesion size is a risk factor for recurrence after piecemeal endoscopic mucosal resection (pEMR). Snare tip soft coagulation (STSC) treatment of the normal-appearing margin after pEMR of lesions ≥ 20 mm has been shown to reduce recurrence rates by 75-80%.

      Aims

      We sought to evaluate the impact of STSC on giant (≥ 40 mm) lateral spreading lesions treated by pEMR. We describe the relative risk and absolute risks of recurrence with and without STSC margin treatment after EMR of ≥ 40 mm lesions.

      Methods

      We performed a retrospective evaluation of a prospectively collected database on large lesions describing lesion size, location, and methods of resection. We excluded lesions < 40 mm in maximum dimension, those that did not undergo follow-up at our center, and in which argon plasma coagulation (APC) was used for either ablative treatment of residual polyp or margin treatment. Propensity score analysis was used to account for potential differences between patients treated with and without STSC.

      Results

      There were 68 lesions ≥ 40 mm removed by pEMR without STSC treatment and 133 removed and treated with STSC. There were no differences between groups in demographics, polyp size, location, histology and mean follow up time. The recurrence rate in the no treatment group was 35% versus 9% with STSC (p < 0.00001 by direct comparison and p = 0.008 using the propensity score analysis).

      Conclusions

      STSC treatment after pEMR of large lateral spreading lesions in the colorectum reduced recurrences by 75%. However, the absolute recurrence rate of 9% remained clinically significant in the STSC treated group. Short term follow-up after STSC of lesions ≥ 40 mm is still warranted, and additional study of technical factors that eliminate recurrence after pEMR of giant lateral spreading lesions is warranted.

      Acronyms and abbreviations:

      EMR (endoscopic mucosal resection), STSC (snare tip soft coagulation), mm (millimeter), APC (argon plasma coagulation), pEMR (piecemeal endoscopic mucosal resection), vs (versus)
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