Comparison of three electrosurgical modes for endoscopic mucosal resection of 10- to 20-mm colorectal polyps: Randomized controlled trial.

Background and study aims: Endocut Q (effect 2, effect 3 and effect 4) commonly is used for endoscopic mucosal resection (EMR) when removing colorectal polyps. However, there is debate over the type of electrosurgical setting of Endocut Q being recommended in clinical practice. We performed a randomized controlled trial to assess effectiveness and safety of three effects with EMR for removal of non-pedunculated 10- to 20-mm colorectal polyps.

Patients and methods: Patients with non-pedunculate colorectal polyps undergoing EMR were randomly allocated into effect 2, effect 3, and effect 4 groups. The primary outcome was rates of intra-procedural bleeding. Secondary outcomes were rates of post-procedural bleeding, perforation, complete resection, en bloc resection, R0 resection, and residual polyps.

Results: A total of 2637 eligible patients were included in the study and randomly assigned into the effect 2, effect 3, or effect 4 group. There were no significant differences among the three groups in baseline characteristics ( P > 0.05). In addition, no significant differences were observed in rates of post-procedural bleeding, perforation, complete resection, en bloc resection, R0 resection, residual polyps, or post-polypectomy syndrome ( P > 0.05). However, the rate of intra-procedural bleeding was significantly lower in the effect 2 group than in the effect 3 and effect 4 groups (4.0% vs. 12.2% vs. 12.7%, P < 0.01).

Conclusions: Endocut Q (effect 2, effect 3 and effect 4) was effective and safe for removing 10- to 20-mm non-pedunculated colorectal polyps. However, effect 2 may be superior to effect 3 and effect 4 in reducing intra-procedural bleeding.