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

H Pohl; IS Grimm; MT Moyer; MK Hasan; D Pleskow; BJ Elmunzer; MA Khashab; O Sanaei; FH Al-Kawas; SR Gordon; A Mathew; JM Levenick; HR Aslanian; F Antaki; D von Renteln; SD Crockett; A Rastogi; JA Gill; RJ Law; PA Elias; M Pellise; TA Mackenzie; DK Rex

doi:10.1055/s-0039-1681265

Endoscopy, Inhaltsverzeichnis

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

Autor*innen

H Pohl

¹VAMC White River Junction/Dartmouth Medical School, Lyme, United States
IS Grimm

²University of North Carolina School of Medicine, Chapel Hill, United States
MT Moyer

³Penn State Hershey Medical Center, Hershey, United States
MK Hasan

⁴Florida Hospital, Orlando, United States
D Pleskow

⁵Beth Israel Deaconess Medical Center, Boston, United States
BJ Elmunzer

⁶Medical University of South Carolina, Charleston, United States
MA Khashab

⁷Johns Hopkins Hospital, Baltimore, United States
O Sanaei

⁷Johns Hopkins Hospital, Baltimore, United States
FH Al-Kawas

⁸Sibley Memorial Hospital, Washington, United States
SR Gordon

⁹Dartmouth-Hitchcock Medical Center, Lebanon, United States
A Mathew

³Penn State Hershey Medical Center, Hershey, United States
JM Levenick

³Penn State Hershey Medical Center, Hershey, United States
HR Aslanian

¹⁰Yale-New Haven Hospital, New Haven, United States
F Antaki

¹¹John D. Dingell Veterans Affairs Medical Center and Wayne State University, Detroit, United States
D von Renteln

¹²University of Montreal Medical Center (CHUM), Montreal, Canada
SD Crockett

²University of North Carolina School of Medicine, Chapel Hill, United States
A Rastogi

¹³University of Kansas Medical Center, Kansas City, United States
JA Gill

¹⁴James A. Haley VA, University of South Florida, Tampa, United States
RJ Law

¹⁵University of Michigan, Ann Arbor, United States
PA Elias

⁶Medical University of South Carolina, Charleston, United States
M Pellise

¹⁶Hospital Clínic de Barcelona, Barcelona, Spain
TA Mackenzie

¹⁷The Dartmouth Institute, Lebanon, United States
DK Rex

¹⁸Indiana University School of Medicine, Indianapolis, United States

Abstract

Volltext

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.