Endoscopy 2019; 51(04): S32-S33
DOI: 10.1055/s-0039-1681265
ESGE Days 2019 oral presentations
Friday, April 5, 2019 11:00 – 13:00: Colon: resection South Hall 2B
Georg Thieme Verlag KG Stuttgart · New York

ELECTROCAUTERY SETTING DOES NOT AFFECT EFFICACY AND SAFETY OF ENDOSCOPIC RESECTION OF LARGE COLORECTAL POLYPS

H Pohl
1   VAMC White River Junction/Dartmouth Medical School, Lyme, United States
,
IS Grimm
2   University of North Carolina School of Medicine, Chapel Hill, United States
,
MT Moyer
3   Penn State Hershey Medical Center, Hershey, United States
,
MK Hasan
4   Florida Hospital, Orlando, United States
,
D Pleskow
5   Beth Israel Deaconess Medical Center, Boston, United States
,
BJ Elmunzer
6   Medical University of South Carolina, Charleston, United States
,
MA Khashab
7   Johns Hopkins Hospital, Baltimore, United States
,
O Sanaei
7   Johns Hopkins Hospital, Baltimore, United States
,
FH Al-Kawas
8   Sibley Memorial Hospital, Washington, United States
,
SR Gordon
9   Dartmouth-Hitchcock Medical Center, Lebanon, United States
,
A Mathew
3   Penn State Hershey Medical Center, Hershey, United States
,
JM Levenick
3   Penn State Hershey Medical Center, Hershey, United States
,
HR Aslanian
10   Yale-New Haven Hospital, New Haven, United States
,
F Antaki
11   John D. Dingell Veterans Affairs Medical Center and Wayne State University, Detroit, United States
,
D von Renteln
12   University of Montreal Medical Center (CHUM), Montreal, Canada
,
SD Crockett
2   University of North Carolina School of Medicine, Chapel Hill, United States
,
A Rastogi
13   University of Kansas Medical Center, Kansas City, United States
,
JA Gill
14   James A. Haley VA, University of South Florida, Tampa, United States
,
RJ Law
15   University of Michigan, Ann Arbor, United States
,
PA Elias
6   Medical University of South Carolina, Charleston, United States
,
M Pellise
16   Hospital Clínic de Barcelona, Barcelona, Spain
,
TA Mackenzie
17   The Dartmouth Institute, Lebanon, United States
,
DK Rex
18   Indiana University School of Medicine, Indianapolis, United States
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 

Aims:

The type of electrocautery setting that should be used for polyp resection has long been a matter of debate. It remains unknown whether the type of electrocautery setting affects resection efficacy, risk of adverse events, or recurrence rates. We aimed to compare two commonly used electrocautery settings for endoscopic mucosal resection of large colorectal polyps in a multicenter, randomized trial.

Methods:

Patients with a ≥20 mm non-pedunculated colorectal polyp were randomized in a 2 × 2 design to clip closure or no clip closure of the mucosal defect (reported at DDW 2018) and to one of two electrocautery settings: forced coagulation or Endocut (ERBE). Related to electrocautery setting, the primary outcome was the incidence of severe adverse events during or within 30 days following the procedure (per patient analysis). Secondary outcomes were technical resection characteristics and recurrence at first surveillance colonoscopy (per polyp analysis).

Results:

928 patients (mean age 65, 59% men) were randomized, 919 patients completed 30-day follow-up, and 658 patients (71%) completed the first surveillance colonoscopy after a median of 6 months. Resection with Endocut more frequently caused intraprocedural bleeding than forced coagulation (17% vs. 11%, p = 0.02), while other technical outcomes were similar (e.g. complete resection, piecemeal resection, need for adjunctive means, time of resection). Severe adverse events occurred in 7.3% and 8.0% in the respective groups, with no difference in the occurrence of types of events. Similarly, no difference was seen in polyp recurrence at surveillance colonoscopy, which was observed in 17.7% in the Endocut group and17.5% in the forced coagulation group.

Conclusions:

This first randomized trial on electrocautery settings for the resection of large non-pedunculated colorectal polyps showed a difference in intraprocedural bleeding; however, neither setting was superior with respect to important safety and efficacy outcomes. Selection of electrocautery setting may therefore be based on expertise and preference of the endoscopist.