Monday abstractMo1061 COLD SNARE PIECEMEAL ENDOSCOPIC MUCOSAL RESECTION (CSP-EMR) OF LARGE SESSILE COLONIC POLYPS ≥20 MM IS FEASIBLE, SAFE AND EFFECTIVE
Introduction
Endoscopic Mucosal Resection (EMR) is the standard of care for resection of large (≥20 mm) non-malignant sessile colonic polyps. Serious adverse events are mostly due to electrocautery. This could potentially be avoided by cold snare EMR. We hypothesized that aggressive wide field cold snare piecemeal EMR (CSP-EMR) could be as effective as conventional EMR, but with fewer adverse events. The study aimed to evaluate safety and efficacy of CSP-EMR of sessile colonic polyps sized ≥20mm.
Section snippets
Patients and Methods
All cases of CSP-EMR performed by a single endoscopist (A.M) at two academic hospitals for sessile polyps ≥20 mm, from Jan 2016 - Dec 2017, were identified retrospectively. During this period, all lesions that were not suspicious for submucosal invasion, and were not very large Paris 0-Is lesions where cold snare resection would be technically very difficult, were performed by CSP-EMR. Efficacy was defined as the absence of residual or recurrent polyp during the first surveillance colonoscopy,
Results
148 polyps sized ≥20mm were successfully excised by CSP-EMR in 133 patients (median age 67 yrs, men 31.1%). Mean polyp size was 25.3 mm (range: 20-60 mm) and 137 (92.5%) polyps were Paris class 0-IIa. 85% of polyps were lifted with submucosal injection before resection. Histology was 90 (60.8%) sessile serrated adenomas, 42 (28.4%) tubular adenomas and 13 (8.8%) tubulovillous adenomas. Cytological dysplasia was absent in 89 (60.1%), low-grade in 57 (38.5%) and high-grade in 2 (1.3%). 110 of 133
Conclusion
CSP-EMR of sessile colonic polyps ≥20mm is technically feasible and appears at least as effective as conventional EMR, but with a superior adverse event profile. We hypothesise that the enhanced safety of cold snare resection allowed for an aggressive and wide field resection that reduces recurrence rates. A randomised controlled trial or large prospective observational studies are required to more rigorously demonstrate the non-inferiority and improved safety profile of CSP-EMR compared to