Endoscopy 2020; 52(S 01): S211
DOI: 10.1055/s-0040-1704657
ESGE Days 2020 ePoster Podium presentations
Saturday, April 25, 2020 10:00 – 10:30 EMR in colon 1 ePoster Podium 1
© Georg Thieme Verlag KG Stuttgart · New York

SNARE TIP SOFT COAGULATION OF THE MUCOSAL DEFECT MARGIN FOLLOWING COLONIC ENDOSCOPIC MUCOSAL RESECTION (EMR) REDUCES RECURRENCE IN A ‘REAL LIFE’ SETTING

MA Arisha
1   Rambam Health Care Campus, Gastroenterology, Haifa, Israel
,
A Koritni
1   Rambam Health Care Campus, Gastroenterology, Haifa, Israel
,
I Maza
1   Rambam Health Care Campus, Gastroenterology, Haifa, Israel
,
E Half
1   Rambam Health Care Campus, Gastroenterology, Haifa, Israel
,
H Awadie
2   Holy Family Hospital, Gastroenterology, Nazareth, Israel
,
S Bana
2   Holy Family Hospital, Gastroenterology, Nazareth, Israel
,
R Muaalem
2   Holy Family Hospital, Gastroenterology, Nazareth, Israel
,
A Klein
1   Rambam Health Care Campus, Gastroenterology, Haifa, Israel
2   Holy Family Hospital, Gastroenterology, Nazareth, Israel
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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    Aims EMR is the treatment of choice for Large (>20 mm) colonic lateral spreading lesions (LSL) wuth high success rates, good safety profile and multiple advantages compared with surgery. A recent randomized study from Australia, demonstrated that ablation of the post-EMR mucosal defect margin using snare tip soft coagulation (STSC) significantly reduced polyp recurrence at surveillance.

    We aimed to determine the efficacy of this technique for reducing polyp recurrence in a ‘real life’ setting.

    Methods Analysis of a prospectively collected database of LSL≥ 20 mm was performed in two hospitals in Israel. Standard EMR technique was used in all cases emphasizing complete snare excision followed by thermal ablation of the entire defect margin. Surveillance colonoscopy was performed 4-6 month after resection. Recurrence was assessed endoscopically with High Definition White Light (HDWL), and Narrow Band Imaging (NBI). Normal appearing scars were randomly biopsied as were any scars suspicious for recurrence. The primary endpoint was lesion recurrence at first surveillance colonoscopy.

    Results Over 36 months 334 LSL in 304 patients were removed by EMR. 275/334 (82.3%) were removed piecemeal. 288/334 (86%) lesions were treated with ablation of the margin. 200/334 (60%) completed first surveillance colonoscopy. Biopsies from post EMR scars were performed in 79 cases (random biopsies from normal appearing scars n=68; biopsied from suspected recurrence in n=11). In standard lesions (excluding previously attempted, fully circumferential, ICV, peri-appendix lesions) recurrence was suspected endoscopically and confirmed histologically in 6 cases (3%). Overall in the entire cohort, histologically confirmed recurrence occurred in 12 lesions (6%).

    Conclusions Ablation of the mucosal defect margin following colonic EMR results in very low recurrence rates in a ‘real life’ setting, which is accurately identified endoscopically. STSC should be performed routinely following piecemeal colonic EMR


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