Colon to Rectum
Clin Gastroenterol Hepatol. 2024;22(3):552–61.e4
Snare tip soft coagulation vs. argon plasma coagulation vs. no margin treatment after large non-pedunculated colorectal polyp resection: A randomized trial
Background and aims: Thermal treatment of the defect margin after endoscopic mucosal resection (EMR) of large non-pedunculated colorectal lesions reduces the recurrence rate. Both snare tip soft coagulation (STSC) and argon plasma coagulation (APC) have been used for thermal margin treatment, but there are few data directly comparing STSC with APC for this indication.
Methods: The authors performed a randomized 3-arm trial in 9 US centers comparing STSC with APC with no margin treatment (control) of defects after EMR of colorectal non-pedunculated lesions ≥ 15 mm. The primary end point was the presence of residual lesion at first follow-up.
Results: There were 384 patients and 414 lesions randomized, and 308 patients (80.2%) with 328 lesions completed ≥ 1 follow-up. The proportion of lesions with residual polyp at first follow-up was 4.6% with STSC, 9.3% with APC, and 21.4% with control subjects (no margin treatment). The odds of residual polyp at first follow-up were lower for STSC and APC when compared with control subjects (p = 0.001 and p = 0.01, respectively). The difference in odds was not significant between STSC and APC. STSC took less time to apply than APC (median, 3.35 vs. 4.08 minutes; p = 0.019). Adverse event rates were low, with no difference between arms.
Conclusions: In a randomized trial snare tip soft coagulation (STSC) and argon plasma coagulation (APC) were each superior to no thermal margin treatment after endoscopic mucosal resection (EMR). STSC was faster to apply than APC. Because STSC also results in lower cost and plastic waste than APC (APC requires an additional device), this study supports STSC as the preferred thermal margin treatment after colorectal EMR.