Safety And Efficacy oF Hot Versus Cold Avulsion for Treatment Of Residual, Non-Lifting Colonic Polyps During EMR Procedure

Aims Endoscopic mucosal resection (EMR) of removal of large (≥20mm) colorectal polyps may be challenging in the presence of submucosal fibrosis. Avulsion with a biopsy forceps has been used to treat fibrotic areas, either with (hot) or without electrocautery (cold). We aimed to compare safety and efficacy of hot and cold avulsion to remove residual polyp during EMR.

Methods We conducted a secondary analysis of data from three different prospective multicenter studies which evaluated the efficacy and safety of EMR procedures that required either hot or cold avulsion to treat residual tissue during lesion resection.

Results 277 (35.4 % female) patients underwent EMR of 288 large colorectal polyps that required either hot (n=140) or cold (n=148) avulsion. Patients who underwent hot avulsion less frequently used antithrombotic medications, had slightly smaller polyps (median size 32 vs 30 mm), and a higher proportion of polyps with prior resection attempts. Other characteristics were comparable. There was no difference between hot and cold avulsion groups in the rate of immediate bleeding (23.6 % vs. 17.6 %) or the rate of serious adverse events (7.4 % vs. 7.8 %) ([table]). Both methods had a similar neoplasia recurrence rate during first surveillance colonoscopy (21.8 % vs. 22.7 %). When accounting for baseline differences in multivariate analysis, avulsion method was not associated with recurrent neoplasia (OR=1.35 95 %CI 0.68-2.66, p = 0.39).

Tab. 1

	Hot avulsion (140 polyps in 136 patients)	Cold avulsion (148 polyps in 141 patients)	p-value
Bleeding during resection requiring intervention, n (%)	33 (23.6)	26 (17.6)	0.2
Severe adverse events, n (%)	10 (7.4	11 (7.8)	0.2
-Bleeding, n (%)	9 (6.6)	6 (4.2)
-Perforation, n (%)	0	2 (1.4)
-Other, n (%)	1 (0.7)	3 (2.1)
Recurrence at 1st surveillance colonoscopy, n/N (%)	24/110 (21.8)	25/110 (22.7)	0.8

Conclusions To our knowledge this is largest study to date comparing hot and cold avulsion to remove residual tissue during EMR of large laterally spreading colorectal lesions. Safety and efficacy outcomes were similar between the two techniques. The higher recurrence rates compared to previous studies emphasize the challenges with resecting non-lifting tissue. The results suggest that choice of technique can be based on endoscopist preference.

Citation: Senada PA, Pohl H, Raimondo M et al. OP104 SAFETY AND EFFICACY OF HOT VERSUS COLD AVULSION FOR TREATMENT OF RESIDUAL, NON-LIFTING COLONIC POLYPS DURING EMR PROCEDURE. Endoscopy 2021; 53: S44.

Publication History

Article published online:
19 March 2021