Margin ablation averts polyp recurrence

Ablation of endoscopic mucosal resection (EMR) margins effectively prevents the recurrence of colorectal polyps at first surveillance colonoscopy, reveals a study.

A team of investigators searched major databases for randomized controlled trials (RCTs) comparing EMR of large nonpedunculated colorectal polyps with and without treated margins from inception until November 2023. They analysed pooled data for recurrence at first screening colonoscopy and adverse events. A random effects model was used for the analysis.

Five RCTs, including 1,020 polyps (577 in treatment and 443 in control groups), met the eligibility criteria. Three studies involved treatment with soft tip snare coagulation (STSC), while three used argon plasma coagulation (APC) as the modality for margin ablation.

More than half (53 percent) of the patients were female, and the mean age was comparable between treatment and control groups (65.9 vs 66.1 years). Of the lesions, 71 percent were proximal to the splenic flexure. The mean follow-up to the first screening colonoscopy was similar between groups (6.3 vs 6.2 months), as was the average polyp size (28.2 vs 28.0 mm).

In pooled analysis, margin ablation resulted in significantly lower rates of recurrence (odds ratio [OR], 0.267, 95 percent confidence interval [CI], 0.18‒0.4; p<0.001), with low heterogeneity between studies (I², 0 percent; p=0.47).

Moreover, there was no significant difference in recurrence (OR, 0.6, 95 percent CI, 0.27‒1.7; I², 0 percent; p=0.3) or adverse events (R, 0.67, 95 percent CI, 0.3‒1.6; I², 13 percent; p=0.46) between STSC and APC.

“We found no difference between STSC or APC in terms of polyp recurrence or adverse outcomes,” the investigators said.