Endoscopy 2020; 52(S 01): S111
DOI: 10.1055/s-0040-1704343
ESGE Days 2020 oral presentations
Saturday, April 25, 2020 08:30 – 10:30 Large colonic polyps: Slice and dice The Liffey B
© Georg Thieme Verlag KG Stuttgart · New York

THERMAL ABLATION OF THE MUCOSAL DEFECT MARGIN AFTER ENDOSCOPIC MUCOSAL RESECTION SIGNIFICANTLY REDUCES ADENOMA RECURRENCE - A PROSPECTIVE, INTERNATIONAL, MULTI-CENTRE TRIAL

, International Colonic Endoscopic Resection Consortium (iACE)
M Sidhu
1   Westmead Hospital, Westmead, Australia
,
DJ Tate
1   Westmead Hospital, Westmead, Australia
2   University Hospital Ghent, Ghent, Belgium
,
L Hourigan
3   Greenslopes Private Hospital, Brisbane, Australia
4   Gallipoli Research Foundation, Brisbane, Australia
,
S Raftopoulos
5   Sir Charles Gairdner Hospital, Perth, Australia
,
A Moss
6   Western Health, Melbourne, Australia
,
S Heitman
7   University of Calgary, Calgary, Canada
,
N Shahidi
1   Westmead Hospital, Westmead, Australia
,
NG Burgess
1   Westmead Hospital, Westmead, Australia
,
E Lee
1   Westmead Hospital, Westmead, Australia
,
S Williams
1   Westmead Hospital, Westmead, Australia
,
MJ Bourke
1   Westmead Hospital, Westmead, Australia
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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    Aims Thermal ablation of the defect margin (TAM) after endoscopic mucosal resection (EMR) in the treatment of large (≥20mm) laterally spreading lesions (LSL) has been shown to be efficacious in a clinical trial setting, with a four-fold reduction, in residual or recurrent adenoma (RRA) at 6 months first surveillance colonoscopy (SC1). The clinical effectiveness of this treatment is unknown.

    We sought to evaluate the effectiveness of TAM and the rate of RRA in an international, multi-centre prospective trial (NCT02957058).

    Methods We conducted a study of consecutive LSL, across six tertiary centres, referred for EMR. The primary endpoint was the rate of RRA at SC1. TAM was performed using soft coagulation via the snare-tip to create a minimum 2-3mm rim of completely ablated tissue around the entire circumference of the resection defect. All endoscopists underwent an educational intervention prior to enrolment. Recurrence was assessed endoscopically and at histology. Exclusion criteria included LSL involving the ileo-caecal valve/appendiceal orifice and circumferential LSL.

    Results From, 05/2016-08/2018, 866 LSL were enrolled and underwent EMR. TAM with uniform completeness was achieved in 795 LSL. 71 LSL had incomplete treatment with TAM (poor access - 26, unstable patient/sedation issues - 15, deep mural injury (>/=3) - 10, massive lesion (LSL > 70mm)/high risk of significant stenosis - 8, other - 12). 424/494 (85.4%) of eligible LSL, treated with complete TAM. 9/424 (2.1%) cases had RRA. All recurrences were easily treated endoscopically. The overall RRA was 23/474 (4.9%) and higher in LSL with incomplete TAM (28%).

    Conclusions In clinical practice routine thermal ablation of the defect margin after EMR is highly effective in reducing recurrence. This simple and inexpensive technique should be universally employed. Incomplete treatment, in difficult lesions, is associated with a higher rate of recurrence and thus complete margin ablation should be attempted in all LSL undergoing EMR.


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