Background and aims
Increasing lesion size is a risk factor for recurrence after piecemeal EMR (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% to 80%. 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 care at our center,
and those in which argon plasma coagulation 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, histologic features, and mean follow-up time. The recurrence rate
in the no-treatment group was 35% versus 9% with STSC (P < .00001 by direct comparison and P = .008 by using the propensity score analysis).
Conclusion
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 care 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.
Abbreviations:
APC (argon plasma coagulation), ESD (endoscopic submucosal dissection), pEMR (piecemeal endoscopic mucosal resection), STSC (snare-tip soft coagulation)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 24, 2022
Accepted:
October 16,
2022
Received:
July 29,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
DISCLOSURE: Dr Rex is a consultant for Olympus Corporation, Boston Scientific, Aries Pharmaceutical, Braintree Laboratories, Lumendi, Ltd., Norgine, Endokey, GI Supply, Medtronic, and Acacia Pharmaceuticals; the recipent of research support from EndoAid, Olympus Corporation, Medivators, Erbe USA Inc, and Braintree Laboratories; and a shareholder in Satisfai Health. The remaining authors disclosed no financial relationships.
Identification
Copyright
© 2022 by the American Society for Gastrointestinal Endoscopy
