Impact of margin thermal ablation after cold-forceps avulsion with snare-tip soft coagulation for non-lifting large non-pedunculated colorectal polyps

医学 结肠镜检查 外科 不利影响 粘膜切除术 撕脱 前瞻性队列研究 内科学 胃肠病学 结直肠癌 内窥镜检查 癌症
作者
Francesco Vito Mandarino,Timothy H. O’Sullivan,Julia Gauci,Clarence Kerrison,Anthony Whitfield,Brian Lam,Varan Perananthan,Sunil Gupta,Oliver Cronin,Renato Medas,David J. Tate,Eric Y. Lee,Nicholas G. Burgess,Michael J. Bourke
出处
期刊:Endoscopy [Georg Thieme Verlag KG]
标识
DOI:10.1055/a-2535-7559
摘要

Background and study aims: Non-lifting large non-pedunculated colorectal polyps (NL-LNPCPs) account for 15% of LNPCP and are effectively managed by Endoscopic Mucosal Resection with adjunctive Cold-forceps Avulsion with adjuvant Snare-Tip soft coagulation (CAST). However, recurrence rates > 10% at surveillance colonoscopy is a significant limitation. We aimed to compare the outcomes of CAST with MTA versus CAST alone for NL-LNPCPs. Patient and methods: Prospective observational data on consecutive patients with NL-LNPCPs treated by EMR and CAST at a single tertiary center was retrospectively evaluated. Two cohorts were established: the pre-MTA period (January 2012-June 2017) and the MTA period (July 2017-October 2023). The primary outcome was the residual/recurrent adenoma (RRA) rate at first surveillance colonoscopy (SC1). Secondary outcomes included RRA at SC2 and adverse events. Results: Over 142 months, 300 patients underwent EMR and CAST for LNPCP: 103 lesions pre-MTA and 197 with MTA. At SC1 and SC2, recurrence was lower in the MTA cohort compared to the pre-MTA cohort (5.0% vs. 18.8%, p<0.001 and 0.8% vs. 10.0%, p<0.001, respectively). Adverse events were similar between the two cohorts [deep mural injury types III-V (pre-MTA 2.9% vs MTA 5.6%, p=0.29), delayed bleeding (pre-MTA 8.7% vs MTA 7.1%, p=0.49)]. On multivariate analysis, MTA was the only variable independently associated with a reduced likelihood of recurrence (OR 0.20, 95% CI 0.07–0.54; P = 0.001). Conclusions: For NL-LNPCPs, MTA in combination with CAST is safe and effective and reduces recurrence at SC1 in comparison to CAST alone.
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