A127 ENDOSCOPIC MUCOSAL RESECTION WITH HYBRID-ARGON PLASMA ABLATION TO PREVENT RECURRENCE OF 20 MM NON-PEDUNCULATED COLORECTAL POLYPS: A MULTI-CENTER PROSPECTIVE CLINICAL STUDY

R. Djinbachian, J. Levenick, S. Bouchard, M. Moyer, E. Deslandres, J. Mosko, C. Teshima, N. Shahidi, D. von Renteln
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Abstract

Abstract Background Endoscopic mucosal resection (EMR) is the mainstay of therapy for non-pedunculated colorectal polyps 20 mm or larger. Post EMR recurrence rates are about 15% if no margin ablation technique is used. Aims Study aim was to evaluate recurrence rates if hybrid Argon Plasma Coagulation ablation (h-APC) is routinely used after the EMR to ablate the margins, base and vessels. Methods A prospective multi-center study including adult patients (18-89 years) undergoing EMR of non-pedunculated colorectal polyps 20 mm or larger was conducted. h-APC was used to ablate all post EMR margins and to ablate the post EMR resection surface and visible submucosal vessels. The primary outcome was the biopsy proven recurrence rate at the first follow-up colonoscopy (4-6 months after EMR). All the resection sites were visually inspected, and biopsies were obtained from the EMR scar. Secondary outcomes included technical success and complication rates. Results A total of 220 EMRs were performed during the study for h-APC ablation of non-pedunculated colorectal polyps, with a size of ≥20 mm. The average size of the polyps included in the study was 35.7 mm (ranging from 20 mm to 100 mm). Among all resected polyps, 16.8% were sessile serrated lesions (SSL), while 66.3% were adenomas. Additionally, 4 cases of cancer were in the study. The application of hot snare EMR with h-APC ablation was technically successful and completed for all cases. The mean duration of the EMR procedure was 19.6 minutes, ranging from 2.3 to 103 minutes, while the mean duration of h-APC ablation was 6.4 minutes, ranging from 1 to 65 minutes. A total of 147 EMRs with follow up examination (57 EMR involving lesions 40mm or larger) are available currently. The overall recurrence rate was 1.3% (2 out of 147 cases). For cases where complete base ablation was achieved, there was a 0% recurrence rate, including lesions 40mm or larger. For lesions measuring 40mm or larger, the recurrence rate was 1.8% (1 out of 54 cases). Out of the 220 total EMRs conducted, perforations were observed in 0.9% (2 cases, managed conservatively with antibiotics only), and clinically significant bleeding occurred in 2.3% (5 cases). In particular, clinically significant bleeding was noted in 2.3% (4 out of 167 cases) of lesions without clipping and in 4.0% (4 out of 99 cases) for right-sided lesions without clipping. Conclusions In this multicenter study EMR in combination with h-APC demonstrated a high technical success rate with low complication rates and showed very low post EMR recurrence in the preliminary data analysis. Funding Agencies Erbe
A127 用混合氩等离子消融术进行内镜下粘膜切除术以预防 20 毫米非梗阻性大肠息肉复发:一项多中心前瞻性临床研究
摘要 背景 内镜黏膜切除术(EMR)是治疗 20 毫米或更大的非梗阻性结直肠息肉的主要方法。如果不使用边缘消融技术,EMR 术后复发率约为 15%。目的 研究目的是评估在 EMR 后常规使用混合氩等离子体凝固消融术(h-APC)消融边缘、基底和血管的复发率。方法 对 20 毫米或更大的非梗阻性结直肠息肉进行 EMR 的成年患者(18-89 岁)进行了一项前瞻性多中心研究。h-APC 用于消融 EMR 后的所有边缘,消融 EMR 后的切除面和可见的粘膜下血管。主要结果是首次随访结肠镜检查(EMR 后 4-6 个月)时活检证实的复发率。对所有切除部位进行目视检查,并从EMR疤痕处获取活检组织。次要结果包括技术成功率和并发症发生率。结果 研究期间共进行了220例EMR,对大小≥20毫米的非梗阻性结直肠息肉进行了h-APC消融。参与研究的息肉平均大小为 35.7 毫米(从 20 毫米到 100 毫米不等)。在所有切除的息肉中,16.8%为无柄锯齿状病变(SSL),66.3%为腺瘤。此外,研究还发现了 4 例癌症病例。所有病例均成功完成了热套管EMR和h-APC消融术。EMR手术的平均持续时间为19.6分钟,从2.3分钟到103分钟不等,而h-APC消融术的平均持续时间为6.4分钟,从1分钟到65分钟不等。目前共有 147 例 EMR 接受了随访检查(57 例 EMR 涉及 40 毫米或更大的病灶)。总体复发率为 1.3%(147 例中有 2 例)。在实现完全基底消融的病例中,包括 40 毫米或更大的病灶在内,复发率为 0%。对于 40 毫米或更大的病灶,复发率为 1.8%(54 例中有 1 例)。在总共进行的220例EMR中,有0.9%(2例,仅使用抗生素进行保守治疗)观察到穿孔,2.3%(5例)出现临床重大出血。特别是,2.3%的病例(167 例中的 4 例)未剪除病灶,4.0%的病例(99 例中的 4 例)未剪除右侧病灶,均出现了明显的临床出血。结论 在这项多中心研究中,EMR 联合 h-APC 技术成功率高,并发症发生率低,初步数据分析显示,EMR 术后复发率非常低。资助机构 Erbe
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