Endoscopy 2025; 57(S 02): S213-S214
DOI: 10.1055/s-0045-1805525
Abstracts | ESGE Days 2025
Moderated poster
The Cutting Edge – Endoscopic resection in the colon 04/04/2025, 08:30 – 09:30 Poster Dome 1 (P0)

Snare tip soft coagulation vs argon plasma coagulation after large non-pedunculated colorectal polyp resection: a meta-analysis of randomized trials

E Smith
1   Baylor Scott ' White Health, Department of Medicine, Round Rock, United States of America
,
D Ramai
2   Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women’s Hospital, Boston, United States of America
3   Harvard Medical School, Boston, United States of America
,
W Yizhong
4   Department of Medicine, Baylor Scott and White Health, Round Rock, United States of America
,
W Yichen
5   Division of Hospital Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, United States of America
,
M Maida
6   Department of Medicine and Surgery, University of Enna ‘Kore’, Enna, Italy
7   Gastroenterology Unit, Umberto I Hospital, Enna, Italy
,
S D Dushyant
8   Division of Gastroenterology, Hepatology ' Motility, The University of Kansas School of Medicine, Kansas City, United States of America
,
S Chandan
9   CHI Health Creighton University Medical Center, Omaha, United States of America
,
A Facciorusso
10   Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
,
M Spadaccini
11   Gastroenterology and Digestive Endoscopy Unit, Humanitas Research Hospital, Rozzano, Italy
,
A Shaukat
12   Division of Gastroenterology ' Hepatology, New York University, New York, United States of America
› Author Affiliations
› Further Information
Also available ateRef
 
 

    Aims Thermal ablative methods (such as argon plasma coagulation (APC) and soft tip snare coagulation (STSC) are commonly used to treat polyp margins. We aim to appraise the current literature and compare clinical outcomes between patients with treated (with APC vs STSC) and non-treated EMR margins.

    Methods We searched major databases from inception until November 2023 for RCTs comparing EMR of large non-pedunculated colorectal polyps with and without treated margins. Pooled data was analyzed for the primary outcome of recurrence at first screening colonoscopy, as well as adverse events. Analysis was performed using a random effects model and data was reported using 95% confidence intervals (CI).

    Results A total of five RCTs were found which included 1020 polyps (577 in treatment and 443 in control groups). Three studies included treatment with STSC and three studies used APC as the modality for margin ablation. Of included patients, 53% were female and average age was similar between treatment and control groups (65.9 vs 66.1 years). Overall, 71% of lesions were proximal to the splenic flexure. Mean follow up to first colonoscopy and average polyp size were comparable (6.3 vs 6.2 months; 28.2 mm vs 28.0 mm, respectively). Pooled analysis showed that margin ablation was associated with significantly lower rates of recurrence (OR=0.267, 95% CI 0.18 – 0.4, P<0.001) with low heterogeneity between studies (I2=0%, P=0.47). Pooled analysis showed no significant difference between STSC and APC in terms of recurrence (OR=0.6, 95% CI 0.27 – 1.7, I2=0%, P=0.3) or adverse events (OR=0.67, 95% CI 0.3 – 1.6, I2 13%, P=0.46).

    Conclusions Our study shows that ablation of EMR margins is very effective at preventing recurrence at first surveillance colonoscopy. We found no difference between STSC or APC in terms of polyp recurrence or adverse outcomes.


     

    Conflicts of Interest

    Authors do not have any conflict of interest to disclose.

    Publication History

    Article published online:
    27 March 2025

    © 2025. European Society of Gastrointestinal Endoscopy. All rights reserved.

    Georg Thieme Verlag KG
    Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany