CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(01): E74-E81
DOI: 10.1055/a-1635-6112
Review

Snare tip soft coagulation (STSC) after endoscopic mucosal resection (EMR) of large (> 20 mm) non pedunculated colorectal polyps: a systematic review and meta-analysis

Saurabh Chandan
1   Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, Nebraska, United States
,
Antonio Facciorusso
2   Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy
,
Daryl Ramai
3   Internal Medicine, The Brooklyn Hospital Center, Brooklyn, New York, United States
,
Smit Deliwala
4   Department of Internal Medicine, Hurley Medical Center, Flint, Michigan, United States
,
Babu P. Mohan
5   Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States
,
Lena L. Kassab
6   Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States
,
Peter V. Draganov
7   Gastroenterology, University of Florida Health, Gainesville, Florida, United States
,
Mohamed O. Othman
8   Division of Gastroenterology, Baylor College of Medicine, Houston, Texas, United States
,
Gursimran S. Kochhar
9   Division of Gastroenterology, Hepatology & Nutrition, Allegheny Health Network, Pittsburgh, Pennsylvania, United States
› Author Affiliations

Abstract

Background and study aims Endoscopic mucosal resection (EMR) of laterally spreading tumors (LSTs) > 20 mm in size can be challenging. Piecemeal EMR of these lesions results in high rates of adenoma recurrence at first surveillance colonoscopy (SC1). Snare tip soft coagulation (STSC) of post resection margins is a safe and effective technique to prevent adenoma recurrence. We conducted a systematic review and meta-analysis to evaluate the effectiveness and safety of this technique.

Patients and methods Multiple databases were searched through April 2021 for studies that reported on outcomes of post EMR STSC for LSTs > 20 mm in size. Meta-analysis was performed to determine pooled odds of adenoma recurrence as well as pooled proportion of adverse events including intraprocedural and delayed bleeding as well as intraprocedural perforation events.

Results Six studies including two randomized controlled trials (RCT) and four cohort studies with 2122 patients were included in the final analysis. Overall pooled odds of adenoma recurrence at SC1 with post EMR STSC compared to no STSC was 0.27 (95 % 0.18–0.42; I2 = 0 %), P < 0.001. Pooled rate of adenoma recurrence at SC1 in post EMR STSC cohort was 6 %. Rates of intraprocedural bleeding, delayed bleeding and intraprocedural perforation were 10.3 %, 6.5 % and 2 % respectively.

Conclusions Our results show that thermal ablation of resection margins with STSC in LSTs > 20 mm is a safe and effective technique in reducing the incidence of adenoma recurrence.

Supplementary material



Publication History

Received: 17 May 2021

Accepted: 14 August 2021

Article published online:
14 January 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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