Hybrid argon plasma coagulation-assisted endoscopic mucosal resection for large sessile colon polyps to reduce local recurrence: a prospective pilot study

Victoria L Motz, Courtney Lester, Matthew T Moyer, Jennifer L Maranki, John M Levenick, Victoria L Motz, Courtney Lester, Matthew T Moyer, Jennifer L Maranki, John M Levenick

Abstract

Background: Endoscopic mucosal resection (EMR) of large, sessile colon polyps often results in incomplete resection with subsequent recurrence. The aim of this prospective pilot study was to evaluate the efficacy and safety of a novel technique, hybrid argon plasma coagulation-assisted EMR (hAPC-EMR), to remove large, sessile polyps.

Methods: 40 eligible patients underwent hAPC-EMR for the removal of one or more nonpedunculated colon polyps ≥ 20 mm. Participants were contacted 30 days post-procedure to assess for adverse events and were recommended to return for a surveillance colonoscopy at 6 months to assess for local recurrence.

Results: At the time writing, 32 patients with 35 polyps (median size 27 mm; interquartile range 14.5 mm) resected by hAPC-EMR had undergone the 6-month follow-up colonoscopy. Recurrence rate was 0 % (95 % confidence interval [CI] 0-0) at follow-up. Post-polypectomy bleeding was experienced by three patients (7.5 %; 95 %CI 0.00-0.15), and no patients developed post-polypectomy syndrome.

Conclusion: These preliminary results showed 0 % local recurrence rate at 6 months and demonstrated the safety profile of hAPC-EMR. A large, randomized, controlled trial is required to confirm these results.

Trial registration: ClinicalTrials.gov NCT03567863.

Conflict of interest statement

The authors declare that they have no conflict of interest.

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/).

Figures

Fig. 1
Fig. 1
The hybrid argon plasma coagulation-assisted endoscopic mucosal resection (hAPC-EMR) technique for removal of colon polyps.aCecal polyp. bCecal polyp after the first needleless injection prior to EMR.cThe resection area after EMR and the second needleless injection, and prior to APC of the edges and base.dThe resected area after hAPC of the edges and base.

References

    1. Buchner A M, Guarner-Argente C, Ginsberg G G. Outcomes of EMR of defiant colorectal lesions directed to an endoscopy referral center. Gastrointest Endosc. 2012;76:255–263.
    1. Jayanna M, Burgess N G, Singh R et al.Cost analysis of endoscopic mucosal resection vs surgery for large laterally spreading colorectal lesions. Clin Gastroenterol Hepatol. 2016;14:271–278.
    1. Moss A, Bourke M J, Williams S J et al.Endoscopic mucosal resection outcomes and prediction of submucosal cancer from advanced colonic mucosal neoplasia. Gastroenterology. 2011;140:1909–1918.
    1. Arezzo A, Passera R, Marchese N et al.Systematic review and meta-analysis of endoscopic submucosal dissection vs endoscopic mucosal resection for colorectal lesions. United European Gastroenterol J. 2016;4:18–29.
    1. Klein A, Tate D J, Jayasekeran V et al.Thermal ablation of mucosal defect margins reduces adenoma recurrence after colonic endoscopic mucosal resection. Gastroenterology. 2019;156:604–613.
    1. Manner H, May A, Kouti I et al.Efficacy and safety of hybrid-APC for the ablation of Barrett’s esophagus. Surg Endosc. 2016;30:1364–70.
    1. Brooker J C, Saunders B P, Shah S G et al.Treatment with argon plasma coagulation reduces recurrence after piecemeal resection of large sessile colonic polyps: a randomized trial and recommendations. Gastrointest Endosc. 2002;55:371–375.
    1. Watson J P, Bennett M K, Griffin S M et al.The tissue effect of argon plasma coagulation on esophageal and gastric mucosa. Gastrointest Endosc. 2000;52:342–345.
    1. Rastogi A, Keighley J, Singh V et al.High accuracy of narrow band imaging without magnification for the real-time characterization of polyp histology and its comparison with high-definition white light colonoscopy: a prospective study. Am J Gastroenterol. 2009;104:2422–2430.
    1. Hattori S, Iwatate M, Sano W et al.Narrow-band imaging observation of colorectal lesions using NICE classification to avoid discarding significant lesions. World J Gastroenterol. 2014;6:600–605.
    1. Pohl H, Grimm I S, Moyer M T et al.Clip closure prevents bleeding after endoscopic resection of large colon polyps in a randomized trial. Gastroenterology. 2019;157:977–984.
    1. Jehangir A, Bennett K M, Rettew A C et -polypectomy electrocoagulation syndrome: a rare cause of acute abdominal pain. J Community Hosp Intern Med Perspect. 2015;5:29147.
    1. Reumkens A, Rondagh E J, Bakker C M et -colonoscopy complications: a systematic review, time trends, and meta-analysis of population-based studies. Am J Gastroenterol. 2016;111:1092–1101.
    1. Harris P A, Taylor R, Minor B L et al.The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019;95:103208.
    1. Harris P A, Thielke R, Payne J et al.Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–381.
    1. Knabe M, Pohl J, Gerges C et al.Standardized long-term follow-up after endoscopic resection of large, nonpedunculated colorectal lesions: a prospective two-center study. Am J Gastroenterol. 2014;109:183–189.
    1. Belderbos T D, Leenders M, Moons L M et al.Local recurrence after endoscopic mucosal resection of nonpedunculated colorectal lesions: systematic review and meta-analysis. Endoscopy. 2014;46:388–402.
    1. Ahlenstiel G, Hourigan L F, Brown G et al.Actual endoscopic versus predicted surgical mortality for treatment of advanced mucosal neoplasia of the colon. Gastrointest Endosc. 2014;80:668–676.
    1. Burgess N G, Bassan M S, McLeod D et al.Deep mural injury and perforation after colonic endoscopic mucosal resection: a new classification and analysis of risk factors. Gut. 2017;66:1779–1789.

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