Outcomes of Thermal Ablation of the Mucosal Defect Margin After Endoscopic Mucosal Resection: A Prospective, International, Multicenter Trial of 1000 Large Nonpedunculated Colorectal Polyps

  • Mayenaaz Sidhu
    Affiliations
    Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia

    Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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  • Neal Shahidi
    Affiliations
    Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia

    Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia

    Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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  • Sunil Gupta
    Affiliations
    Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia

    Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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  • Lobke Desomer
    Affiliations
    Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia

    AZ Delta Hospital, Department of Gastroenterology and Hepatology, Roeselare, Belgium
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  • Sergei Vosko
    Affiliations
    Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
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  • W. Arnout van Hattem
    Affiliations
    Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
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  • Luke F. Hourigan
    Affiliations
    Department of Gastroenterology and Hepatology, Greenslopes Private Hospital, Brisbane, Queensland, Australia

    Gallipoli Medical Research Institute, School of Medicine, The University of Queensland, Greenslopes Private Hospital, Brisbane, Queensland, Australia
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  • Eric Y.T. Lee
    Affiliations
    Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
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  • Alan Moss
    Affiliations
    Department of Gastroenterology and Hepatology, Footscray Hospital, Melbourne, Victoria, Australia

    Department of Medicine, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
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  • Spiro Raftopoulos
    Affiliations
    Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
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  • Steven J. Heitman
    Affiliations
    Departments of Medicine and Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
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  • Stephen J. Williams
    Affiliations
    Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
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  • Simon Zanati
    Affiliations
    Department of Gastroenterology and Hepatology, Footscray Hospital, Melbourne, Victoria, Australia

    Department of Gastroenterology and Hepatology, The Alfred Hospital, Melbourne, Victoria, Australia
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  • David J. Tate
    Affiliations
    Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia

    Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia

    Department of Gastroenterology and Hepatology, University Hospital of Ghent, Ghent, Belgium
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  • Nicholas Burgess
    Affiliations
    Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia

    Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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  • Michael J. Bourke
    Correspondence
    Correspondence Address correspondence to: Michael J. Bourke, MBBS, FRACP,Westmead Hospital, Department of Gastroenterology and Hepatology, University of Sydney, Westmead Clinical School, Suite 106a 151-155 Hawkesbury Road, Sydney, New South Wales, Australia 2145.
    Affiliations
    Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia

    Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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      Background & Aims

      Thermal ablation of the defect margin after endoscopic mucosal resection (EMR-T) for treating large (≥20 mm) nonpedunculated colorectal polyps (LNPCPs) has shown efficacy in a randomized trial, with a 4-fold reduction, in residual or recurrent adenoma (RRA) at first surveillance colonoscopy (SC1). The clinical effectiveness of this treatment, in the real world, remains unknown.

      Methods

      We sought to evaluate the effectiveness of EMR-T in an international multicenter prospective trial (NCT02957058). The primary endpoint was the frequency of RRA at SC1. Detailed demographic, procedural, and outcome data were recorded. Exclusion criteria were LNPCPs involving the ileo-caecal valve, the appendiceal orifice, and circumferential LNPCPs.

      Results

      During 51 months (May 2016–August 2020) 1049 LNPCPs in 1049 patients (median size, 35 mm; interquartile range, 25–45 mm; right colon location, 53.5%) were enrolled. Uniform completeness of EMR-T was achieved in 989 LNPCPs (95.4%). In this study, 755/803 (94.0%) eligible LNPCPs underwent SC1 (median time to SC1, 6 months; interquartile range, 5–7 months). For LNPCPs that underwent complete EMR-T, the frequency of RRA at SC1 was 1.4% (10/707).

      Conclusions

      In clinical practice, EMR-T is a simple, inexpensive, and highly effective auxiliary technique that is likely to significantly reduce RRA at first surveillance. It should be universally used for the management of LNPCPs after EMR.
      https://clinicaltrials.gov; Clinical Trial Number, NCT02957058.

      Graphical abstract

      Keywords

      Abbreviations used in this paper:

      APC (argon plasma coagulation), CI (confidence interval), CSPEB (clinically significant post-endoscopic mucosal resection bleeding), DMI (deep mural injury), EMR (endoscopic mucosal resection), EMR-T (thermal ablation of the defect margin after EMR), ESD (endoscopic submucosal dissection), IPB (intraprocedural bleeding), IQR (interquartile range), LNPCP (large nonpedunculated colorectal polyp), RR (relative risk), RRA (residual or recurrent adenoma), SC1 (first surveillance colonoscopy), SD (standard deviation), SMIC (submucosal invasive cancer), STSC (snare-tip soft coagulation), X-EMR (extended EMR)
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