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
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.
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.
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).
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.