Multicenter International Study Confirms That Snare-Tip Soft Coagulation of EMR Margin Dramatically Lowers Recurrence Rate
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Multicenter International Study Confirms That Snare-Tip Soft Coagulation of EMR Margin Dramatically Lowers Recurrence Rate

Douglas K. Rex, MD, MASGE, reviewing Sidhu M, et al. Gastroenterology 2021 Mar 30.

A previous randomized controlled trial showed that thermal ablation of a normal-appearing EMR margin after complete polyp resection reduced the recurrence rate from 21% to 5%. Since then, emphasis has been placed on the need for a systematic, complete ablation of the entire margin. In a follow-up uncontrolled study of 1037 nonpedunculated lesions ≥20 mm in size, removed at multiple centers in several countries, the recurrence rate at follow-up was 1.4%.

Douglas K. Rex, MD, FASGE

COMMENT

This study confirms that thermal injury of the mucosa at the margin after complete resection by snare-tip soft coagulation and avulsion, if needed, is the most important recent advance in the EMR technique. It lowers the recurrence rate after piecemeal resection to the same level as that with endoscopic submucosal dissection (ESD) and removes recurrence as an argument for colorectal ESD over EMR.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Sidhu M, Shahidi N, Gupta S, et al. Outcomes of thermal ablation of the mucosal defect margin after endoscopic mucosal resection: a prospective, international, multi-centre trial of 1000 large non-pedunculated colorectal polyps. Gastroenterology 2021 Mar 30. (Epub ahead of print) (https://doi.org/10.1053/j.gastro.2021.03.044)

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