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Prophylactic Snare Tip Soft Coagulation and Its Impact on Adenoma Recurrence After Colonic Endoscopic Mucosal Resection

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Abstract

Background

Up to 20% of patients can have recurrence of adenomatous tissue at first surveillance study after colon endoscopic mucosal resection of large polyps.

Aims

To determine whether an educational intervention discussing thermal ablation of lateral margins of the mucosectomy site of post-endoscopic mucosal resection defect with snare tip soft coagulation (STSC) would decrease adenoma recurrence.

Methods

We performed a single-center quality improvement project from November 1, 2016, to November 30, 2017. Gastroenterologists underwent an educational intervention demonstrating the treatment of peripheral margins of mucosectomy site with STSC after standard mucosectomy technique. These cases (intervention group) were compared with consecutive procedures performed prior to commencement of the quality improvement study (pre-intervention group). Patients with large colorectal lesions (≥ 20 mm) were included.

Results

Of the 120 patients here included, overall demographics of the groups were similar and the most common histology was sessile serrated adenoma (study group 45% vs 32% control group). Adenoma recurrence on intervention group and pre-intervention group was 12% versus 30%; p = 0.01. On univariate analysis, biopsy prior to mucosectomy, intraprocedural bleeding, and application of STSC on mucosectomy defect were the strongest predictors of adenoma recurrence. Adenoma recurrence in the intervention group was significantly lower than in the pre-intervention group in both univariate (odds ratio, 0.3 [95% CI, 0.11–0.80]) and multivariate analyses (odds ratio, 0.2 [95% CI, 0.12–0.92]).

Conclusions

The implementation of STSC of post-endoscopic mucosal resection peripheral defects is clinically feasible and significantly decreased adenoma recurrence.

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Abbreviations

EMR:

Endoscopic mucosal resection

Nd:YAG:

Neodymium-doped yttrium aluminum garnet

SC1:

First surveillance colonoscopy

STSC:

Snare tip soft coagulation

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Funding

Victoria Gómez reports consulting relationships with Olympus. Michael B. Wallace reports consulting income from Lumendi and Cosmo Pharmaceuticals and grant support from Boston Scientific, Olympus, Fujifilm and Medtronic.

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Author notes

  1. Pujan Kandel and Monia E. Werlang have contributed equally to this work.

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA

    Pujan Kandel, Monia E. Werlang, Issac R. Ahn, Timothy A. Woodward, Massimo Raimondo, Ernest P. Bouras, Michael B. Wallace & Victoria Gómez

Authors
  1. Pujan Kandel
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  2. Monia E. Werlang
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  3. Issac R. Ahn
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  6. Ernest P. Bouras
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  7. Michael B. Wallace
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  8. Victoria Gómez
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Correspondence to Victoria Gómez.

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Kandel, P., Werlang, M.E., Ahn, I.R. et al. Prophylactic Snare Tip Soft Coagulation and Its Impact on Adenoma Recurrence After Colonic Endoscopic Mucosal Resection. Dig Dis Sci 64, 3300–3306 (2019). https://doi.org/10.1007/s10620-019-05666-8

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