Download PDF
CC BY-NC-ND 4.0 · Endoscopy 2022; 54(06): 580-584
DOI: 10.1055/a-1677-3954
Innovations and brief communications

Hybrid argon plasma coagulation-assisted endoscopic mucosal resection for large sessile colon polyps to reduce local recurrence: a prospective pilot study

Victoria L. Motz 
1   Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, United States
,
Courtney Lester
2   Division of Gastroenterology and Hepatology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States
,
Matthew T. Moyer
2   Division of Gastroenterology and Hepatology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States
,
Jennifer L. Maranki
2   Division of Gastroenterology and Hepatology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States
,
John M. Levenick
2   Division of Gastroenterology and Hepatology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States
› Author AffiliationsTrial Registration: ClinicalTrials.gov Registration number (trial ID): NCT03567863 Type of study: Multicenter randomized crossover trial
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background Endoscopic mucosal resection (EMR) of large, sessile colon polyps often results in incomplete resection with subsequent recurrence. The aim of this prospective pilot study was to evaluate the efficacy and safety of a novel technique, hybrid argon plasma coagulation-assisted EMR (hAPC-EMR), to remove large, sessile polyps.

Methods 40 eligible patients underwent hAPC-EMR for the removal of one or more nonpedunculated colon polyps ≥ 20 mm. Participants were contacted 30 days post-procedure to assess for adverse events and were recommended to return for a surveillance colonoscopy at 6 months to assess for local recurrence.

Results At the time writing, 32 patients with 35 polyps (median size 27 mm; interquartile range 14.5 mm) resected by hAPC-EMR had undergone the 6-month follow-up colonoscopy. Recurrence rate was 0 % (95 % confidence interval [CI] 0–0) at follow-up. Post-polypectomy bleeding was experienced by three patients (7.5 %; 95 %CI 0.00–0.15), and no patients developed post-polypectomy syndrome.

Conclusion These preliminary results showed 0 % local recurrence rate at 6 months and demonstrated the safety profile of hAPC-EMR. A large, randomized, controlled trial is required to confirm these results.



Publication History

Received: 23 February 2021

Accepted after revision: 04 August 2021

Article published online:
14 December 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Buchner AM, Guarner-Argente C, Ginsberg GG. Outcomes of EMR of defiant colorectal lesions directed to an endoscopy referral center. Gastrointest Endosc 2012; 76: 255-263
    CrossrefPubMedSearch in Google Scholar
  • 2 Jayanna M, Burgess NG, Singh R. et al. Cost analysis of endoscopic mucosal resection vs surgery for large laterally spreading colorectal lesions. Clin Gastroenterol Hepatol 2016; 14: 271-278
    CrossrefPubMedSearch in Google Scholar
  • 3 Moss A, Bourke MJ, Williams SJ. et al. Endoscopic mucosal resection outcomes and prediction of submucosal cancer from advanced colonic mucosal neoplasia. Gastroenterology 2011; 140: 1909-1918
    CrossrefPubMedSearch in Google Scholar
  • 4 Arezzo A, Passera R, Marchese N. et al. Systematic review and meta-analysis of endoscopic submucosal dissection vs endoscopic mucosal resection for colorectal lesions. United European Gastroenterol J 2016; 4: 18-29
    CrossrefPubMedSearch in Google Scholar
  • 5 Klein A, Tate DJ, Jayasekeran V. et al. Thermal ablation of mucosal defect margins reduces adenoma recurrence after colonic endoscopic mucosal resection. Gastroenterology 2019; 156: 604-613
    CrossrefPubMedSearch in Google Scholar
  • 6 Manner H, May A, Kouti I. et al. Efficacy and safety of hybrid-APC for the ablation of Barrett’s esophagus. Surg Endosc 2016; 30: 1364-70
    CrossrefPubMedSearch in Google Scholar
  • 7 Brooker JC, Saunders BP, Shah SG. et al. Treatment with argon plasma coagulation reduces recurrence after piecemeal resection of large sessile colonic polyps: a randomized trial and recommendations. Gastrointest Endosc 2002; 55: 371-375
    CrossrefPubMedSearch in Google Scholar
  • 8 Watson JP, Bennett MK, Griffin SM. et al. The tissue effect of argon plasma coagulation on esophageal and gastric mucosa. Gastrointest Endosc 2000; 52: 342-345
    CrossrefPubMedSearch in Google Scholar
  • 9 Rastogi A, Keighley J, Singh V. et al. High accuracy of narrow band imaging without magnification for the real-time characterization of polyp histology and its comparison with high-definition white light colonoscopy: a prospective study. Am J Gastroenterol 2009; 104: 2422-2430
    CrossrefPubMedSearch in Google Scholar
  • 10 Hattori S, Iwatate M, Sano W. et al. Narrow-band imaging observation of colorectal lesions using NICE classification to avoid discarding significant lesions. World J Gastroenterol 2014; 6: 600-605
    CrossrefPubMedSearch in Google Scholar
  • 11 Pohl H, Grimm IS, Moyer MT. et al. Clip closure prevents bleeding after endoscopic resection of large colon polyps in a randomized trial. Gastroenterology 2019; 157: 977-984
    CrossrefPubMedSearch in Google Scholar
  • 12 Jehangir A, Bennett KM, Rettew AC. et al. Post-polypectomy electrocoagulation syndrome: a rare cause of acute abdominal pain. J Community Hosp Intern Med Perspect 2015; 5: 29147
    CrossrefPubMedSearch in Google Scholar
  • 13 Reumkens A, Rondagh EJ, Bakker CM. et al. Post-colonoscopy complications: a systematic review, time trends, and meta-analysis of population-based studies. Am J Gastroenterol 2016; 111: 1092-1101
    CrossrefPubMedSearch in Google Scholar
  • 14 Harris PA, Taylor R, Minor BL. et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform 2019; 95: 103208
    CrossrefPubMedSearch in Google Scholar
  • 15 Harris PA, Thielke R, Payne J. et al. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42: 377-381
    CrossrefPubMedSearch in Google Scholar
  • 16 Knabe M, Pohl J, Gerges C. et al. Standardized long-term follow-up after endoscopic resection of large, nonpedunculated colorectal lesions: a prospective two-center study. Am J Gastroenterol 2014; 109: 183-189
    CrossrefPubMedSearch in Google Scholar
  • 17 Belderbos TD, Leenders M, Moons LM. et al. Local recurrence after endoscopic mucosal resection of nonpedunculated colorectal lesions: systematic review and meta-analysis. Endoscopy 2014; 46: 388-402
    Thieme ConnectPubMedSearch in Google Scholar
  • 18 Ahlenstiel G, Hourigan LF, Brown G. et al. Actual endoscopic versus predicted surgical mortality for treatment of advanced mucosal neoplasia of the colon. Gastrointest Endosc 2014; 80: 668-676
    CrossrefPubMedSearch in Google Scholar
  • 19 Burgess NG, Bassan MS, McLeod D. et al. Deep mural injury and perforation after colonic endoscopic mucosal resection: a new classification and analysis of risk factors. Gut 2017; 66: 1779-1789
    CrossrefPubMedSearch in Google Scholar