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Prophylactic Snare Tip Soft Coagulation and Its Impact on Adenoma Recurrence After Colonic Endoscopic Mucosal
Pujan Kandel1, Monia E Werlang1, Issac R Ahn1
1Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
Digestive Diseases and Sciences
|May 18, 2019
Summary
Thermal ablation of colon polyp resection margins using snare tip soft coagulation (STSC) significantly reduces adenoma recurrence after endoscopic mucosal resection. This quality improvement project demonstrates a feasible method to improve patient outcomes and prevent polyp regrowth.
Area of Science:
- Gastroenterology
- Endoscopic Surgery
- Oncology
Background:
- Adenoma recurrence after colorectal endoscopic mucosal resection (EMR) for large polyps affects up to 20% of patients.
- Standard EMR techniques may leave residual adenomatous tissue, necessitating effective surveillance strategies.
Purpose of the Study:
- To evaluate if an educational intervention on thermal ablation of resection margins using snare tip soft coagulation (STSC) decreases adenoma recurrence post-EMR.
- To assess the clinical feasibility and impact of STSC on preventing adenoma regrowth.
Main Methods:
- A single-center quality improvement project compared patients undergoing EMR with STSC (intervention group) to those before the intervention (pre-intervention group).
- Gastroenterologists received training on STSC application to the peripheral margins of the EMR site.
- The study included patients with large colorectal lesions (≥20 mm).
Main Results:
- Adenoma recurrence was significantly lower in the intervention group (12%) compared to the pre-intervention group (30%) (p=0.01).
- Univariate and multivariate analyses confirmed STSC application as a significant predictor for reduced adenoma recurrence (OR 0.2-0.3).
- Factors like prior biopsy and intraprocedural bleeding were identified as predictors of recurrence.
Conclusions:
- Implementing STSC for post-EMR peripheral defects is clinically feasible.
- STSC significantly decreases adenoma recurrence after endoscopic mucosal resection of large colorectal polyps.
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