COLD ENDOSCOPIC MUCOSAL RESECTION OF 8 – 20MM SESSILE SERRATED POLYPS: A PROSPECTIVE TRIAL

Aims:

Sessile serrated polyps (SSPs) are recognized as a major contributor to the epidemiologic burden of colorectal cancer, although the optimal technique for their removal remains uncertain. We aimed to prospectively evaluate the efficacy and safety of cold endoscopic mucosal resection (c-EMR) for SSPs sized 8 – 20 mm.

Methods:

Consecutive adults referred for elective colonoscopy at two endoscopy units in Greece (3/2018 – 10/2018) were prospectively enrolled if they had at least one polyp 8 – 20 mm with optical features (narrow band imaging with magnification) suggestive of SSP. Patients on anticoagulants or antiplatelets other than aspirin were excluded. Lesions were resected using a stiff snare (size range: 9 – 20 mm) and a c-EMR technique comprising submucosal injection of a methylene blue-tinted normal saline solution. Outcomes were the presence of residual serrated neoplasia in post-polypectomy biopsies (4 biopsies obtained from the margins/1 from the base) and the occurrence of complications.

Results:

A total of 38 patients (63.2% females, mean 55.3 ± 9.9 years) with 40 pathologically confirmed SSPs were enrolled. The mean size was 13.7 ± 3.9 mm: 34 (80%) SSPs were ≥10 mm, 24 (60%) SSPs were ≥15 mm and 31 (77.5%) were proximal to the transverse colon. Cytological dysplasia was present in 6 (15%). A total of 22 (55%) lesions (mean size 10.8 ± 2.9) were resected en bloc. In lesions resected piecemeal, the median number of resected pieces per case was 2 (range: 2 – 3). Marginal biopsies were positive in 2 (5%) lesions; all base biopsies were negative. Intraprocedural bleeding (> 60 minutes) requiring haemostatic clip application occurred in 1 (2.5%) case. No delayed bleeding or perforation occurred within 2 weeks of follow-up.

Conclusions:

c-EMR is effective and safe technique for the removal of SSPs sized 8 – 20 mm.