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  • Endoscopic mucosal resection for large non-pedunculated colorectal polyps: staying on track with a safe, effective and cost-efficient technique

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Endoscopic mucosal resection for large non-pedunculated colorectal polyps: staying on track with a safe, effective and cost-efficient technique
  1. Francesco Vito Mandarino1,
  2. Renato Medas1,2,
  3. Julia L Gauci1,
  4. Clarence Kerrison1,3,
  5. Anthony Whitfield1,3,
  6. Sunil Gupta1,3,
  7. Stephen J Williams1,
  8. Eric Y Lee1,
  9. Nicholas G Burgess1,3,
  10. Michael J Bourke1,3
  1. 1 Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
  2. 2 Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
  3. 3 The University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Dr Francesco Vito Mandarino, Gastroenterology and Hepatology, Westmead Hospital, Westmead, NSW 2145, Australia; francescovito.mandarino{at}health.nsw.gov.au

https://doi.org/10.1136/gutjnl-2023-331402

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    We congratulate Djinbachian et al on their recent publication that addressed the utility of hybrid argon plasma coagulation (hAPC) to mitigate recurrence after endoscopic mucosal resection (EMR) of large non-pedunculated colorectal polyps (LNPCPs).1 In a 3-centre study, involving 391 patients (427 LNPCPs), they reported a lower residual or recurrent adenoma rate (RRA of 0.9%) with combined margin and base ablation, when compared with margin ablation alone (8.8%) or no ablation (23.4%).

    The insights presented in this paper open discussion on the potential enhancement of EMR outcomes. Our extensive 15-year research experience at Westmead Hospital, Sydney, aligns closely with this topic.

    The authors’ rationale behind base ablation is the need to treat polyp areas that might evade capture during a piecemeal resection. However, a systematic approach to LNPCP EMR may preclude its occurrence. This involves a systematic resection, starting from the lesion’s edge, ensuring a wide margin and proceeding in a one-way direction. Once the submucosal plane is entered, it is important that subsequent snare placement …

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    Footnotes

    • FVM and RM contributed equally.

    • Contributors FVM and RM planned the manuscript, did the literature review and created the first draft. JLG, CK, AMW and SG did the literature review and revision of the manuscript. SJW and EYL did a critical expert review. NGB and MJB did a critical expert review and approved the final version of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests MJB: research support from Olympus, Cook Medical and Boston Scientific. All other authors have no competing interests.

    • Provenance and peer review Not commissioned; internally peer reviewed.