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 24 November 2017

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News

Treatment with argon plasma coagulation reduces recurrence after piecemeal resection of large sessile colonic polyps

Recurrence is a frequent problem after piecemeal snare resection of large sessile colorectal polyps. A team from the Endoscopy Unit at St. Mark's Hospital in London, England, carried out research into the safety and efficacy of argon plasma coagulation (APC) as a treatment for prevention of polyp recurrence.

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Their report is published in the March issue of the journal Gastrointestinal Endoscopy.

The aim of the study was to examine whether APC was of use in preventing polyp recurrence when applied to the edge and base of the polypectomy site after apparently complete piecemeal resection.

Patients with large (>1.5 cm) sessile polyps removed by piecemeal snare cautery were placed into two groups.

The first group 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.

In this group 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.

APC - can reduce adenomatous recurrence of completely excised polyps.
Gastrointestinal Endoscopy

The researchers found only 1 in 10 patients suffered recurrence after application of APC in the randomized group.

This compared favorably with the control group that did not receive APC, where 7 out of 11 patients had polyp recurrence.

In patients with initial incomplete snare polypectomy, recurrence was detected at 3 months in almost half of the subjects (6 out of 13), despite APC."

In addition, 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.

Dr Jim C. Brooker, concluding on behalf of his colleagues, said the findings show that "In patients with apparent complete endoscopic snare resection of large adenomas, postpolypectomy application of APC does reduce adenomatous recurrence."

Gastrointest Endosc 2002; 55: 371-5
11 March 2002

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