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Cap-fitted endoscopic mucosal resection of ≥ 20 mm colon flat lesions followed by argon plasma coagulation results in a low adenoma recurrence rate

Background and study aims  Endoscopic mucosal resection (EMR) is increasingly used for the treatment of large colonic polyps (≥ 20 mm). A drawback of EMR is local adenoma recurrence. Therefore, we studied the impact of argon plasma coagulation (APC) of the EMR edge on local adenoma recurrence. Patie...

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Autores principales: Raju, Gottumukkala S., Lum, Phillip, Abu-Sbeih, Hamzah, Ross, William A., Thirumurthi, Selvi, Miller, Ethan, Lynch, Patrick, Lee, Jeffrey, Bhutani, Manoop S., Shafi, Mehnaz, Weston, Brian, Rashid, Asif, Wang, Yinghong, Chang, George J., Carlson, Richard, Hagan, Katherine, Davila, Marta, Stroehlein, John
Formato: Online Artículo Texto
Lenguaje:English
Publicado: © Georg Thieme Verlag KG 2020
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6976333/
https://www.ncbi.nlm.nih.gov/pubmed/32010742
http://dx.doi.org/10.1055/a-1012-1811
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author Raju, Gottumukkala S.
Lum, Phillip
Abu-Sbeih, Hamzah
Ross, William A.
Thirumurthi, Selvi
Miller, Ethan
Lynch, Patrick
Lee, Jeffrey
Bhutani, Manoop S.
Shafi, Mehnaz
Weston, Brian
Rashid, Asif
Wang, Yinghong
Chang, George J.
Carlson, Richard
Hagan, Katherine
Davila, Marta
Stroehlein, John
author_facet Raju, Gottumukkala S.
Lum, Phillip
Abu-Sbeih, Hamzah
Ross, William A.
Thirumurthi, Selvi
Miller, Ethan
Lynch, Patrick
Lee, Jeffrey
Bhutani, Manoop S.
Shafi, Mehnaz
Weston, Brian
Rashid, Asif
Wang, Yinghong
Chang, George J.
Carlson, Richard
Hagan, Katherine
Davila, Marta
Stroehlein, John
author_sort Raju, Gottumukkala S.
collection PubMed
description Background and study aims  Endoscopic mucosal resection (EMR) is increasingly used for the treatment of large colonic polyps (≥ 20 mm). A drawback of EMR is local adenoma recurrence. Therefore, we studied the impact of argon plasma coagulation (APC) of the EMR edge on local adenoma recurrence. Patients and methods  This was a retrospective study of patients with laterally spreading tumors (LST) ≥ 20 mm, who underwent EMR from January 2009 to August 2018 and follow-up endoscopic assessment. A cap-fitted endoscope was used to assess completeness of resection by systematically inspecting the EMR defect for any macroscopic disease. This was followed by forced APC of the resection edge followed by clip closure of the defect. Surveillance colonoscopy was performed at 6 months after resection to detect recurrence. Results  Two hundred forty-six patients met the inclusion criteria. Most were female (53 %) and white (80 %), with a Median age of 64 years. Median polyp size was 35 mm (interquartile range, 30–45 mm). Most polyps were located in the right colon (77 %) and were removed by piecemeal EMR (70 %). Eleven patients (5 %) had residual tumor at the resection site. Conclusions  We observed low adenoma recurrence after argon plasma coagulation of the EMR edge with a cap fitted colonoscope in patients with LST ≥ 20 mm of the colon, which requires further validation in a randomized controlled study.
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spelling pubmed-69763332020-02-01 Cap-fitted endoscopic mucosal resection of ≥ 20 mm colon flat lesions followed by argon plasma coagulation results in a low adenoma recurrence rate Raju, Gottumukkala S. Lum, Phillip Abu-Sbeih, Hamzah Ross, William A. Thirumurthi, Selvi Miller, Ethan Lynch, Patrick Lee, Jeffrey Bhutani, Manoop S. Shafi, Mehnaz Weston, Brian Rashid, Asif Wang, Yinghong Chang, George J. Carlson, Richard Hagan, Katherine Davila, Marta Stroehlein, John Endosc Int Open Background and study aims  Endoscopic mucosal resection (EMR) is increasingly used for the treatment of large colonic polyps (≥ 20 mm). A drawback of EMR is local adenoma recurrence. Therefore, we studied the impact of argon plasma coagulation (APC) of the EMR edge on local adenoma recurrence. Patients and methods  This was a retrospective study of patients with laterally spreading tumors (LST) ≥ 20 mm, who underwent EMR from January 2009 to August 2018 and follow-up endoscopic assessment. A cap-fitted endoscope was used to assess completeness of resection by systematically inspecting the EMR defect for any macroscopic disease. This was followed by forced APC of the resection edge followed by clip closure of the defect. Surveillance colonoscopy was performed at 6 months after resection to detect recurrence. Results  Two hundred forty-six patients met the inclusion criteria. Most were female (53 %) and white (80 %), with a Median age of 64 years. Median polyp size was 35 mm (interquartile range, 30–45 mm). Most polyps were located in the right colon (77 %) and were removed by piecemeal EMR (70 %). Eleven patients (5 %) had residual tumor at the resection site. Conclusions  We observed low adenoma recurrence after argon plasma coagulation of the EMR edge with a cap fitted colonoscope in patients with LST ≥ 20 mm of the colon, which requires further validation in a randomized controlled study. © Georg Thieme Verlag KG 2020-02 2020-01-22 /pmc/articles/PMC6976333/ /pubmed/32010742 http://dx.doi.org/10.1055/a-1012-1811 Text en https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.
spellingShingle Raju, Gottumukkala S.
Lum, Phillip
Abu-Sbeih, Hamzah
Ross, William A.
Thirumurthi, Selvi
Miller, Ethan
Lynch, Patrick
Lee, Jeffrey
Bhutani, Manoop S.
Shafi, Mehnaz
Weston, Brian
Rashid, Asif
Wang, Yinghong
Chang, George J.
Carlson, Richard
Hagan, Katherine
Davila, Marta
Stroehlein, John
Cap-fitted endoscopic mucosal resection of ≥ 20 mm colon flat lesions followed by argon plasma coagulation results in a low adenoma recurrence rate
title Cap-fitted endoscopic mucosal resection of ≥ 20 mm colon flat lesions followed by argon plasma coagulation results in a low adenoma recurrence rate
title_full Cap-fitted endoscopic mucosal resection of ≥ 20 mm colon flat lesions followed by argon plasma coagulation results in a low adenoma recurrence rate
title_fullStr Cap-fitted endoscopic mucosal resection of ≥ 20 mm colon flat lesions followed by argon plasma coagulation results in a low adenoma recurrence rate
title_full_unstemmed Cap-fitted endoscopic mucosal resection of ≥ 20 mm colon flat lesions followed by argon plasma coagulation results in a low adenoma recurrence rate
title_short Cap-fitted endoscopic mucosal resection of ≥ 20 mm colon flat lesions followed by argon plasma coagulation results in a low adenoma recurrence rate
title_sort cap-fitted endoscopic mucosal resection of ≥ 20 mm colon flat lesions followed by argon plasma coagulation results in a low adenoma recurrence rate
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6976333/
https://www.ncbi.nlm.nih.gov/pubmed/32010742
http://dx.doi.org/10.1055/a-1012-1811
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