Endoscopy 2023; 55(02): 158-164
DOI: 10.1055/a-1884-7849
Original article

Anchoring endoscopic mucosal resection versus conventional endoscopic mucosal resection for large nonpedunculated colorectal polyps: a randomized controlled trial

Chang Kyo Oh*
1   Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, South Korea
2   Division of Gastroenterology, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University of Korea, Seoul, South Korea
,
Young-Seok Cho*
1   Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, South Korea
,
Sung Hak Lee
3   Departments of Hospital Pathology, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, South Korea
,
1   Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, South Korea
› Author Affiliations
Trial Registration: Clinical Research Information Service, Republic of Korea (https://cris.nih.go.kr) Registration number (trial ID): KCT0004942 Type of study: A randomized controlled trial

Abstract

Background Colorectal polyps > 10 mm in size are often incompletely resected. Anchoring-endoscopic mucosal resection (A-EMR) is the technique of making a small incision at the oral side of the polyp using a snare tip after submucosal injection to avoid slippage during ensnaring. This study was performed to evaluate whether A-EMR could increase the complete resection rate for large colorectal polyps compared with conventional endoscopic mucosal resection (C-EMR).

Methods Polyps with sizes of 10–25 mm were randomly allocated to either the A-EMR or the C-EMR groups.

Results 105 and 106 polyps were resected using A-EMR and C-EMR, respectively. In the intention-to-treat population, the complete resection rate was 89.5 % in the A-EMR group and 74.5 % in the C-EMR group (relative risk [RR] 1.20, 95 %CI 1.04 to 1.38; P = 0.01). The en bloc resection rates for the A-EMR and C-EMR groups were 92.4 % vs. 76.4 % (RR 1.21, 95 %CI 1.06 to 1.37; P = 0.005) and R0 resection rates were 77.1 % vs. 64.2 % (RR 1.18, 95 %CI 0.98 to 1.42; P = 0.07), respectively. The median (interquartile range [IQR]) total procedure time was 3.2 (2.6–4.1) minutes in the A-EMR group and 3.0 (2.2–4.6) minutes in the C-EMR group (median difference 0.2 minutes, 95 %CI −0.22 to 0.73; P = 0.25). There was one episode of delayed bleeding and one perforation in the C-EMR group.

Conclusions A-EMR was superior to C-EMR for the complete resection of large colorectal polyps. A-EMR can be considered one of the standard methods for the removal of colorectal polyps of 10 mm or more in size.

* Joint first authors


Table 1 s



Publication History

Received: 16 February 2022

Accepted after revision: 24 June 2022

Accepted Manuscript online:
24 June 2022

Article published online:
31 August 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
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