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Conventional Endoscopic Mucosal Resection Versus Cold Snare Endoscopic Mucosal Resection of Colonic Lateral Spreading Lesions - A Randomised Controlled Trial

ABSTRACT: Comparing the complete resection rate and subsequent adenoma recurrence rate at surveillance colonoscopy of 15-40mm laterally spreading adenomas for conventional EMR vs. cold snare EMR.

DISEASE(S): Colon Cancer,Colon Adenoma,Colorectal Cancer,Adenoma,Adenoma Colon

PROVIDER: 2320001 | ecrin-mdr-crc |

REPOSITORIES: ECRIN MDR

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Cold Snare Endoscopic Mucosal Resection (EMR) vs Cold EMR With Margin Snare Tip Soft Coagulation (STSC)

Project description:Randomised controlled trial comparing cold snare endoscopic mucosal resection (EMR) with cold snare EMR and adjuvant margin STSC in the complete resection of 15-40mm lateral-spreading adenomas

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Cold snare endoscopic mucosal resection for the removal of large nonpedunculated colon polyps.

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Cold Snare Polypectomy Versus Endoscopic Mucosal Resection for Colonic Sessile Serrated Polyps

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Endoscopic Mucosal Resection Versus Endoscopic Submucosal Dissection for Colorectal Laterally Spreading Lesions.

Project description:EMR and ESD are both effective and safe and are associated with a very low risk of procedure related mortality when performed for colorectal laterally spreading lesions (LSL). Some kind of LSLs have a low risk of submucosal invasive carcinoma (SMIC) or these foci are found in well demarcated areas of the tumor. This is the case of the non-granular flat elevated (LSN-NG-FE) and the LSLs-G mixed subtypes. The investigators aim to assess if piecemeal EMR (the older technique) for LSLs-G mixed type > 30 mm and LSLs-NG FE type > 20 mm is not inferior to ESD (the new treatment) for the need of additional surgery in the mid-term.

| 2354982 | ecrin-mdr-crc

Endoscopic resection for laterally spreading tumor (LST) -(endoscopic submucosal dissecion (ESD) vs. endoscopic mucosal resection)-

Project description:Interventions: Group A. ESD group 1. The solution of a mixture of Glyceol and 1% 1900-KDa hyaluronic acid preparation is injected into the submucosal layer. 2. Mucosal incision is started with the knife for ESD. 3. The lesion is resected with submucosal dissection. Group B. EMR group 1. The solution of normal saline is injected into the submucosal layer. 2. The lesion is resected with an electrosurgical snare. Primary outcome(s): the incidence of local recurrence after endoscopic resection Study Design: Parallel Randomized

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Recurrence rates after piecemeal endoscopic mucosal resection of large colorectal laterally spreading tumors.

Project description:BackgroundPiecemeal endoscopic mucosal resection (pEMR) is routinely employed for large laterally spreading tumors (LSTs). Recurrence rates following pEMR are still unclear, especially when cap-assisted EMR (EMR-c) is performed. We assessed the recurrence rates and recurrence risk factors post-pEMR for large colorectal LSTs, including both wide-field EMR (WF-EMR) and EMR-c.MethodsThis was a single-center, retrospective study of consecutive patients who underwent pEMR for colorectal LSTs ≥20 mm at our institution between 2012 and 2020. Patients had a post-resection follow-up period of at least 3 months. A risk factor analysis was carried out using the Cox regression model.ResultsThe analysis included 155 pEMR: 51 WF-EMR and 104 EMR-c, with a median lesion size of 30 (range: 20-80) mm and a median endoscopic follow up of 15 (range: 3-76) months. Overall, disease recurrence occurred in 29.0% of cases; there was no significant difference in recurrence rates between WF-EMR and EMR-c. Recurrent lesions were safely managed by endoscopic removal, and at risk analysis lesion size was the only significant risk factor for recurrence (mm; hazard ratio 1.03, 95% confidence interval 1.00-1.06, P=0.02).ConclusionsRecurrence of large colorectal LSTs after pEMR occurs in 29% of cases. This rate is mainly dependent on lesion size, and the use of a cap during pEMR has no effect on recurrence. Prospective controlled trials are needed to validate these results.

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Follow-up Protocol of Colorectal Endoscopic Mucosal Resection Scars

Project description:Nowadays endoscopic mucosal resection (EMR) is the gold standard for the removal of large laterally spreading and sessile colorectal lesions ≥ 20 mm. However, recurrence rate after successful EMR (defined by the absence of neoplastic tissue at the completion of the procedure after careful inspection of the post-EMR mucosal defect and margin) is about 15-20%. Consequently, current guidelines recommend a surveillance colonoscopy between 4 and 6 months after resection for detection of residual or recurrent polyp. There are few studies that have examined the accuracy of advanced endoscopic imaging for the prediction of histological recurrence but none of these imaging modalities have been validated for surveillance after EMR. Therefore, current guidelines strongly recommend systematic biopsy of EMR scar. The main aim of this study is to assess the incremental benefit of narrow band imaging (NBI) and white light endoscopy (WLE) randomizing the initial technique for the endoscopic detection of post-EMR recurrence and to asses if this advanced imaging method achieve sufficient diagnostic accuracy to exclude recurrence without the need for biopsy.

| 2327788 | ecrin-mdr-crc

Endoscopic mucosal resection with anchoring of the snare tip: multicenter retrospective evaluation of effectiveness and safety.

Project description:Background ?Endoscopic mucosal resection (EMR) with snare is the recommended technique to resect non-invasive colorectal neoplastic lesions between 10 and 30?mm in diameter. The objective of EMR is to resect completely the neoplastic tissue en bloc and preferably with free margins (R0), avoiding recurrences. Anchoring the tip of the snare in the submucosa is a technical trick that allows snare sliding to be reduced and larger pieces to be caught. The aim of the present study was to evaluate the effectiveness and safety of anchoring-EMR (A-EMR). Methods ?This was a retrospective analysis of A-EMR procedures for lesions of diameter between 10 and 30?mm (endoscopic evaluation) performed consecutively in four French centers between May 2017 and January 2018. A-EMR was routinely performed for all EMR using Olympus conventional snares (10 or 25?mm). The primary outcome was evaluation of the proportion of R0 resections. Results ?A total of 141 A-EMR procedures were performed by 10 operators. Mean lesion size was 19.8?mm. Anchoring was feasible in 96.5?% of cases. There were 81.6?% en bloc resections and 70.2?% R0 resections, with the percentage of procedures decreasing with increasing lesion size (82.8?% <?20?mm, 55.3?% 21?-?30?mm, and 50.0?% >?30?mm, P ?=?0.002). Complete perforations closed endoscopically occurred in 3/141 cases (2.1?%); none occurred in lesions?<?20?mm in size (0?/87). Conclusion ?The A-EMR technique appears to be promising with a high proportion of R0 for lesions of 10?-?20?mm in size without any perforations. It could also offer an alternative to endoscopic submucosal dissection (ESD), or to hybrid techniques to reach R0 for lesions between 20 and 30?mm in size.

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Anchoring the snare tip is a feasible endoscopic mucosal resection method for small rectal neuroendocrine tumors.

Project description:Small rectal neuroendocrine tumors (NETs) can be treated using cap-assisted endoscopic mucosal resection (EMR-C), which requires additional effort to apply a dedicated cap and snare. We aimed to evaluate the feasibility of a simpler modified endoscopic mucosal resection (EMR) technique, so-called anchored snare-tip EMR (ASEMR), for the treatment of small rectal NETs, comparing it with EMR-C. We retrospectively evaluated 45 ASEMR and 41 EMR-C procedures attempted on small suspected or established rectal NETs between July 2015 and May 2020. The mean (SD) lesion size was 5.4 (2.2) mm and 5.2 (1.7) mm in the ASEMR and EMR-C groups, respectively (p = 0.558). The en bloc resection rates of suspected or established rectal NETs were 95.6% (43/45) and 100%, respectively (p = 0.271). The rates of histologic complete resection of rectal NETs were 94.1% (32/34) and 88.2% (30/34), respectively (p = 0.673). The mean procedure time was significantly shorter in the ASEMR group than in the EMR-C group (3.12 [1.97] vs. 4.13 [1.59] min, p = 0.024). Delayed bleeding occurred in 6.7% (3/45) and 2.4% (1/41) of patients, respectively (p = 0.618). In conclusion, ASEMR was less time-consuming than EMR-C, and showed similar efficacy and safety profiles. ASEMR is a feasible treatment option for small rectal NETs.

| S-EPMC8217176 | biostudies-literature

Assessing the safety of routine snare tip soft coagulation (STSC) in patients undergoing endoscopic mucosal resection for large polyps during colonoscopy

Project description:Interventions: We are assessing whether additional snare tip soft coagulation (STSC) therapy applied to the resection margins of a defect following piecemeal removal of a large colonic polyp without electrocautery will reduce the risk of polyp recurrence. The safety profile of this intervention will also be assessed (although it has been found to be safe in other large multicentre studies). STSC will be performed using the wire tip of a polypectomy snare. The tip is positioned 1-2mm beyond the end of the snare sheath and thermal ablation is applied to the edges of the polypectomy defect margins using this tip with the assistance of a microprocessor-controlled generator (SOFT COAG mode, 80W Effect 4, ERBE Electromedizin, Tubingen, Germany). The aim will be to create a 2mm circumferential rim of completely ablated tissue around the defect. This typically requires up to 5 minutes of additional procedure time and will be delivered to patients streamlined to the intervention arm of the study. Photodocumentation will be required following STSC. This will be performed by gastroenterologists who have experience in both resection of large polyps and application of STSC. Primary outcome(s): Rate of adenoma recurrence following polypectomy +/- STSC. These outcomes will be reviewed at the 6-month mark following a routine post-EMR colonoscopy. Visual inspection and biopsies of the polypectomy site will be obtained. [6 months after index colonoscopy (ie. initial polypectomy procedure)] Study Design: Purpose: Treatment; Allocation: Randomised controlled trial; Masking: Blinded (masking used);Assignment: Parallel;Type of endpoint: Safety/efficacy

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