CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(02): E115-E121
DOI: 10.1055/a-1012-1811
Original article
Owner and Copyright © Georg Thieme Verlag KG 2020

Cap-fitted endoscopic mucosal resection of ≥ 20 mm colon flat lesions followed by argon plasma coagulation results in a low adenoma recurrence rate

Gottumukkala S. Raju
1   Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
,
Phillip Lum
1   Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
,
Hamzah Abu-Sbeih
1   Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
,
William A. Ross
1   Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
,
Selvi Thirumurthi
1   Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
,
Ethan Miller
1   Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
,
Patrick Lynch
1   Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
,
Jeffrey Lee
1   Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
,
Manoop S. Bhutani
1   Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
,
Mehnaz Shafi
1   Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
,
Brian Weston
1   Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
,
Asif Rashid
2   Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
,
Yinghong Wang
1   Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
,
George J. Chang
3   Department of Colorectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
,
Richard Carlson III
3   Department of Colorectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
,
Katherine Hagan
3   Department of Colorectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
,
Marta Davila
1   Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
,
John Stroehlein
1   Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
› Author Affiliations
Further Information

Publication History

submitted 08 May 2019

accepted after revision 26 June 2019

Publication Date:
22 January 2020 (online)

Abstract

Background and study aims Endoscopic mucosal resection (EMR) is increasingly used for the treatment of large colonic polyps (≥ 20 mm). A drawback of EMR is local adenoma recurrence. Therefore, we studied the impact of argon plasma coagulation (APC) of the EMR edge on local adenoma recurrence.

Patients and methods This was a retrospective study of patients with laterally spreading tumors (LST) ≥ 20 mm, who underwent EMR from January 2009 to August 2018 and follow-up endoscopic assessment. A cap-fitted endoscope was used to assess completeness of resection by systematically inspecting the EMR defect for any macroscopic disease. This was followed by forced APC of the resection edge followed by clip closure of the defect. Surveillance colonoscopy was performed at 6 months after resection to detect recurrence.

Results Two hundred forty-six patients met the inclusion criteria. Most were female (53 %) and white (80 %), with a Median age of 64 years. Median polyp size was 35 mm (interquartile range, 30–45 mm). Most polyps were located in the right colon (77 %) and were removed by piecemeal EMR (70 %). Eleven patients (5 %) had residual tumor at the resection site.

Conclusions We observed low adenoma recurrence after argon plasma coagulation of the EMR edge with a cap fitted colonoscope in patients with LST ≥ 20 mm of the colon, which requires further validation in a randomized controlled study.

 
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