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CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(10): E1399-E1405
DOI: 10.1055/a-1922-7646
Review

Post-EMR for colorectal polyps, thermal ablation of defects reduces adenoma recurrence: A meta-analysis[*]

Pujan Kandel‡
1   Michigan State University/Hurley Medical Center, Flint, Michigan, United States
,
Murtaza Hussain‡
1   Michigan State University/Hurley Medical Center, Flint, Michigan, United States
,
Deepesh Yadav
1   Michigan State University/Hurley Medical Center, Flint, Michigan, United States
,
Santosh K. Dhungana
1   Michigan State University/Hurley Medical Center, Flint, Michigan, United States
,
Bhaumik Brahmbhatt
2   Mayo Clinic's Campus in Florida, Jacksonville, Florida, United States
,
Massimo Raimondo
2   Mayo Clinic's Campus in Florida, Jacksonville, Florida, United States
,
Frank J. Lukens
2   Mayo Clinic's Campus in Florida, Jacksonville, Florida, United States
,
Ghassan Bachuwa
1   Michigan State University/Hurley Medical Center, Flint, Michigan, United States
,
Michael B. Wallace
2   Mayo Clinic's Campus in Florida, Jacksonville, Florida, United States
3   Division of Gastroenterology and Hepatology, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
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Abstract

Background and study aims Adenoma recurrence is one of the key limitations of endoscopic mucosal resection (EMR), which occurs in 15 % to 30 % of cases during first surveillance colonoscopy. The main hypothesis behind adenoma recurrence is leftover micro-adenomas at the margins of post-EMR defects. In this systematic review and meta-analysis, we evaluated the efficacy of snare tip soft coagulation (STSC) at the margins of mucosal defects to reduce adenoma recurrence and bleeding complications.

Methods Electronic databases such as PubMed and the Cochrane library were used for systematic literature search. Studies with polyps only resected by piecemeal EMR and active treatment: with STSC, comparator: non-STSC were included. A random effects model was used to calculate the summary of risk ratio and 95 % confidence intervals. The main outcome of the study was to compare the effect of STSC versus non-STSC with respect to adenoma recurrence at first surveillance colonoscopy after thermal ablation of post-EMR defects.

Results Five studies were included in the systematic review and meta-analysis. The total number patients who completed first surveillance colonoscopy (SC1) in the STSC group was 534 and in the non-STSC group was 514. The pooled adenoma recurrence rate was 6 % (37 of 534 cases) in the STSC arm and 22 % (115 of 514 cases) in the non-STSC arm, (odds ratio [OR] 0.26, 95 % confidence interval [CI], 0.16–0.41, P = 0.001). The pooled delayed post-EMR bleeding rate 19 % (67 of 343) in the STSC arm and 22 % (78 of 341) in the non-STSC arm (OR 0.82, 95 %CI, 0.57–1.18).

Conclusions Thermal ablation of post-EMR defects significantly reduces adenoma recurrence at first surveillance colonoscopy.

* Portions of this manuscript have been published in abstract form: Gastrointest Endosc 2021; 93: AB89–AB90.


Supplementary material



Publikationsverlauf

Eingereicht: 23. Januar 2022

Angenommen nach Revision: 10. August 2022

Accepted Manuscript online:
11. August 2022

Artikel online veröffentlicht:
17. Oktober 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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