Original ArticlesTreatment with argon plasma coagulation reduces recurrence after piecemeal resection of large sessile colonic polyps: A randomized trial and recommendations☆,☆☆
Section snippets
Patients and methods
Consecutive patients undergoing colonoscopy with known large benign sessile colonic polyps suitable for endoscopic resection were prospectively enrolled. The study protocol was approved by the ethics committee of our institution. All patients were referred either by other specialists or by colleagues at our hospital. Patients were considered eligible for inclusion in the study if they had large (>1.5 cm) sessile polyps that required piecemeal resection. Patients with known malignant polyps were
Results
Twenty-one polyps in 21 patients (enrolled from July 1998 to December 2000) were judged to have been completely resected with the snare and were randomized to APC (10 polyps) or control (11 polyps). No eligible patients refused to participate. Patients with polyps known to contain malignancy were not considered for entry in the study and none of the polyps from included patients were later found to contain cancer. Complete snare resection was not possible in a further 13 polyps (13 patients),
Discussion
Endoscopic resection of sessile polyps is preferable to surgery because of lower cost and morbidity. However, the tendency for recurrence, with the inherent risk of progression to carcinoma, has been one limitation of the endoscopic approach to date. Previous series have documented adenoma recurrence in up to half of cases5, 6, 7 after apparently complete endoscopic resection. This is presumably because of residual foci of adenomatous tissue that are not visible to the endoscopist. Ablative
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Funded by the Henry Smith Foundation.
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Reprint requests: Brian P. Saunders, MD, Wolfson Unit for Endoscopy, St. Mark's Hospital, Northwick Park, London, HA1 3UJ, United Kingdom.