Prophylactic Snare Tip Soft Coagulation and Its Impact on Adenoma Recurrence After Colonic Endoscopic Mucosal Resection

Pujan Kandel, Monia E. Werlang, Issac R. Ahn, Timothy A. Woodward, Massimo Raimondo, Ernest P. Bouras, Michael B Wallace, Victoria Gómez

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Up to 20% of patients can have recurrence of adenomatous tissue at first surveillance study after colon endoscopic mucosal resection of large polyps. Aims: To determine whether an educational intervention discussing thermal ablation of lateral margins of the mucosectomy site of post-endoscopic mucosal resection defect with snare tip soft coagulation (STSC) would decrease adenoma recurrence. Methods: We performed a single-center quality improvement project from November 1, 2016, to November 30, 2017. Gastroenterologists underwent an educational intervention demonstrating the treatment of peripheral margins of mucosectomy site with STSC after standard mucosectomy technique. These cases (intervention group) were compared with consecutive procedures performed prior to commencement of the quality improvement study (pre-intervention group). Patients with large colorectal lesions (≥ 20 mm) were included. Results: Of the 120 patients here included, overall demographics of the groups were similar and the most common histology was sessile serrated adenoma (study group 45% vs 32% control group). Adenoma recurrence on intervention group and pre-intervention group was 12% versus 30%; p = 0.01. On univariate analysis, biopsy prior to mucosectomy, intraprocedural bleeding, and application of STSC on mucosectomy defect were the strongest predictors of adenoma recurrence. Adenoma recurrence in the intervention group was significantly lower than in the pre-intervention group in both univariate (odds ratio, 0.3 [95% CI, 0.11–0.80]) and multivariate analyses (odds ratio, 0.2 [95% CI, 0.12–0.92]). Conclusions: The implementation of STSC of post-endoscopic mucosal resection peripheral defects is clinically feasible and significantly decreased adenoma recurrence.

Original languageEnglish (US)
JournalDigestive Diseases and Sciences
DOIs
StatePublished - Jan 1 2019

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Adenoma
Recurrence
Quality Improvement
Odds Ratio
Polyps
Endoscopic Mucosal Resection
Histology
Colon
Multivariate Analysis
Hot Temperature
Demography
Hemorrhage
Biopsy
Control Groups

Keywords

  • Adenoma recurrence
  • Colorectal polyps
  • Endoscopic mucosal resection
  • Quality improvement
  • Snare tip soft coagulation

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology

Cite this

Prophylactic Snare Tip Soft Coagulation and Its Impact on Adenoma Recurrence After Colonic Endoscopic Mucosal Resection. / Kandel, Pujan; Werlang, Monia E.; Ahn, Issac R.; Woodward, Timothy A.; Raimondo, Massimo; Bouras, Ernest P.; Wallace, Michael B; Gómez, Victoria.

In: Digestive Diseases and Sciences, 01.01.2019.

Research output: Contribution to journalArticle

Kandel, Pujan ; Werlang, Monia E. ; Ahn, Issac R. ; Woodward, Timothy A. ; Raimondo, Massimo ; Bouras, Ernest P. ; Wallace, Michael B ; Gómez, Victoria. / Prophylactic Snare Tip Soft Coagulation and Its Impact on Adenoma Recurrence After Colonic Endoscopic Mucosal Resection. In: Digestive Diseases and Sciences. 2019.
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abstract = "Background: Up to 20{\%} of patients can have recurrence of adenomatous tissue at first surveillance study after colon endoscopic mucosal resection of large polyps. Aims: To determine whether an educational intervention discussing thermal ablation of lateral margins of the mucosectomy site of post-endoscopic mucosal resection defect with snare tip soft coagulation (STSC) would decrease adenoma recurrence. Methods: We performed a single-center quality improvement project from November 1, 2016, to November 30, 2017. Gastroenterologists underwent an educational intervention demonstrating the treatment of peripheral margins of mucosectomy site with STSC after standard mucosectomy technique. These cases (intervention group) were compared with consecutive procedures performed prior to commencement of the quality improvement study (pre-intervention group). Patients with large colorectal lesions (≥ 20 mm) were included. Results: Of the 120 patients here included, overall demographics of the groups were similar and the most common histology was sessile serrated adenoma (study group 45{\%} vs 32{\%} control group). Adenoma recurrence on intervention group and pre-intervention group was 12{\%} versus 30{\%}; p = 0.01. On univariate analysis, biopsy prior to mucosectomy, intraprocedural bleeding, and application of STSC on mucosectomy defect were the strongest predictors of adenoma recurrence. Adenoma recurrence in the intervention group was significantly lower than in the pre-intervention group in both univariate (odds ratio, 0.3 [95{\%} CI, 0.11–0.80]) and multivariate analyses (odds ratio, 0.2 [95{\%} CI, 0.12–0.92]). Conclusions: The implementation of STSC of post-endoscopic mucosal resection peripheral defects is clinically feasible and significantly decreased adenoma recurrence.",
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T1 - Prophylactic Snare Tip Soft Coagulation and Its Impact on Adenoma Recurrence After Colonic Endoscopic Mucosal Resection

AU - Kandel, Pujan

AU - Werlang, Monia E.

AU - Ahn, Issac R.

AU - Woodward, Timothy A.

AU - Raimondo, Massimo

AU - Bouras, Ernest P.

AU - Wallace, Michael B

AU - Gómez, Victoria

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N2 - Background: Up to 20% of patients can have recurrence of adenomatous tissue at first surveillance study after colon endoscopic mucosal resection of large polyps. Aims: To determine whether an educational intervention discussing thermal ablation of lateral margins of the mucosectomy site of post-endoscopic mucosal resection defect with snare tip soft coagulation (STSC) would decrease adenoma recurrence. Methods: We performed a single-center quality improvement project from November 1, 2016, to November 30, 2017. Gastroenterologists underwent an educational intervention demonstrating the treatment of peripheral margins of mucosectomy site with STSC after standard mucosectomy technique. These cases (intervention group) were compared with consecutive procedures performed prior to commencement of the quality improvement study (pre-intervention group). Patients with large colorectal lesions (≥ 20 mm) were included. Results: Of the 120 patients here included, overall demographics of the groups were similar and the most common histology was sessile serrated adenoma (study group 45% vs 32% control group). Adenoma recurrence on intervention group and pre-intervention group was 12% versus 30%; p = 0.01. On univariate analysis, biopsy prior to mucosectomy, intraprocedural bleeding, and application of STSC on mucosectomy defect were the strongest predictors of adenoma recurrence. Adenoma recurrence in the intervention group was significantly lower than in the pre-intervention group in both univariate (odds ratio, 0.3 [95% CI, 0.11–0.80]) and multivariate analyses (odds ratio, 0.2 [95% CI, 0.12–0.92]). Conclusions: The implementation of STSC of post-endoscopic mucosal resection peripheral defects is clinically feasible and significantly decreased adenoma recurrence.

AB - Background: Up to 20% of patients can have recurrence of adenomatous tissue at first surveillance study after colon endoscopic mucosal resection of large polyps. Aims: To determine whether an educational intervention discussing thermal ablation of lateral margins of the mucosectomy site of post-endoscopic mucosal resection defect with snare tip soft coagulation (STSC) would decrease adenoma recurrence. Methods: We performed a single-center quality improvement project from November 1, 2016, to November 30, 2017. Gastroenterologists underwent an educational intervention demonstrating the treatment of peripheral margins of mucosectomy site with STSC after standard mucosectomy technique. These cases (intervention group) were compared with consecutive procedures performed prior to commencement of the quality improvement study (pre-intervention group). Patients with large colorectal lesions (≥ 20 mm) were included. Results: Of the 120 patients here included, overall demographics of the groups were similar and the most common histology was sessile serrated adenoma (study group 45% vs 32% control group). Adenoma recurrence on intervention group and pre-intervention group was 12% versus 30%; p = 0.01. On univariate analysis, biopsy prior to mucosectomy, intraprocedural bleeding, and application of STSC on mucosectomy defect were the strongest predictors of adenoma recurrence. Adenoma recurrence in the intervention group was significantly lower than in the pre-intervention group in both univariate (odds ratio, 0.3 [95% CI, 0.11–0.80]) and multivariate analyses (odds ratio, 0.2 [95% CI, 0.12–0.92]). Conclusions: The implementation of STSC of post-endoscopic mucosal resection peripheral defects is clinically feasible and significantly decreased adenoma recurrence.

KW - Adenoma recurrence

KW - Colorectal polyps

KW - Endoscopic mucosal resection

KW - Quality improvement

KW - Snare tip soft coagulation

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