Original Articles
Treatment with argon plasma coagulation reduces recurrence after piecemeal resection of large sessile colonic polyps: A randomized trial and recommendations,☆☆

https://doi.org/10.1067/mge.2002.121597Get rights and content

Abstract

Background: Recurrence is frequent after piecemeal snare resection of large sessile colorectal polyps. The aim of this study was to evaluate the safety and efficacy of argon plasma coagulation (APC) in preventing recurrence when applied to the edge and base of the polypectomy site after apparently complete piecemeal resection. Methods: Patients with large (>1.5 cm) sessile polyps removed by piecemeal snare cautery were placed into 2 groups. The first consisted of patients with polyps believed by the endoscopist to be completely excised. These patients were randomized to either no further therapy (control) or to APC of the rim and any residual mucosal or submucosal tissue in the base of the polypectomy site. The second group comprised patients in whom polyps, as judged by the endoscopist, were incompletely excised by snare polypectomy; APC was routinely applied without randomization to all visible remaining adenomatous tissue. Follow-up colonoscopy was performed within 3 months and 1 year; biopsy specimens were taken routinely from the resection site and further polypectomy was performed as indicated. Results: There were fewer recurrences after APC in the randomized group (1/10 APC, 7/11 no APC; p = 0.02). In the group with initial incomplete snare polypectomy, recurrence was detected at 3 months in 6 of 13 despite APC. One patient was hospitalized with abdominal pain and minor rectal bleeding but required no intervention. There were no other episodes of significant late bleeding caused by piecemeal polypectomy. One patient was referred for surgery after unsuccessful endoscopic management. Conclusions: In patients with apparent complete endoscopic snare resection of large adenomas, postpolypectomy application of APC reduces adenomatous recurrence. (Gastrointest Endosc 2002;55:371-5.)

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.

☆☆

Reprint requests: Brian P. Saunders, MD, Wolfson Unit for Endoscopy, St. Mark's Hospital, Northwick Park, London, HA1 3UJ, United Kingdom.

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