Cold snare endoscopic mucosal resection versus standard hot technique for large flat nonpedunculated colonic lesions: a randomized controlled trial

April 29, 2025

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Publicated to:Endoscopy. - 2025-04-15 (), DOI: 10.1055/a-2542-9759

Authors: Nogales, Oscar; Blanco, Carlos Carbonell; Pina, Sheyla Montori; Pellise, Maria; Sempere, Juan F Martinez; Pons, Fausto Riu; Mangas-Sanjuan, Carolina; Daca-Alvarez, Maria; Uchima, Hugo; Aranda-Hernandez, Javier; Delgado, Alberto Alvarez; de Santiago, Enrique Rodriguez; Garcia, Jose Santiago; Ruiz, Angel Canet; Garcia, Pablo Miranda; Rodriguez, Henar Nunez; Herreros-de-Tejada, Alberto; Cortazar, Eduardo Valdivielso; De Maria, Pedro; Busquets, David; Elosua, Alfonso; Rivero-Sanchez, Liseth; Lopez-Ibanez, Maria; Alvarez-Gonzalez, Marco A; Albeniz, Eduardo

Affiliations

Clin Rotger Quironsalud, Dept Digest Dis, Palma De Mallorca, Spain - Author

Complexo Hosp Univ A Coruna, Dept Digest Dis, La Coruna, Spain - Author

Hosp Garcia Orcoyen, Internal Med Dept, Digest Dis Unit, Estella, Spain - Author

Hosp Gen Univ Dr Balmis, Endoscopy Unit, Inst Invest Sanit & Biomed Alicante, ISABIAL, Alicante, Spain - Author

Hosp Gen Univ Gregorio Maranon, Dept Gastroenterol & Hepatol, C Doctor Esquerdo 46, Madrid 28007, Spain - Author

Hosp Mar Res Inst, Dept Gastroenterol, Barcelona, Spain - Author

Hosp Univ Doctor Josep Trueta Girona, Dept Digest Dis, Girona, Spain - Author

Hosp Univ Germans Trias i Pujol, Dept Digest Dis, Badalona, Spain - Author

Hosp Univ La Paz, Dept Digest Dis, Madrid, Spain - Author

Hosp Univ Princesa, Dept Digest Dis, Madrid, Spain - Author

Hosp Univ Rio Hortega, Dept Digest Dis, Valladolid, Spain - Author

Hosp Univ Salamanca, Dept Digest Dis, Salamanca, Spain - Author

Navarra Inst Hlth Res, IdiSNA, Pamplona, Spain - Author

Univ Alcala, Hosp Univ Ramon & Cajal, Dept Gastroenterol & Hepatol, Inst Ramon & Cajal Invest Sanit IRYCIS,CIBEREHD, Madrid, Spain - Author

Univ Autonoma Madrid, Hosp Univ Puerta Hierro Majadahonda, Dept Digest Dis, IDIPHISA, Madrid, Spain - Author

Univ Barcelona, Hosp Clin Barcelona, Inst Invest Biomed August Pi i Sunyer IDIBAPS, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Barcelona, Spain - Author

Univ Publ Navarra UPNA, Hosp Univ Navarra HUN, Navarra Inst Hlth Res, Gastroenterol Dept,Endoscopy Unit,Navarrabiomed,Id, Pamplona, Spain - Author

Univ Publ Navarra UPNA, Hosp Univ Navarra HUN, Navarra Inst Hlth Res, Gastroenterol Res Unit,Navarrabiomed,IdiSNA, Pamplona, Spain - Author

Abstract

BackgroundsCold snare EMR (CS-EMR) in large flat nonpedunculated colonic lesions (LFNPCLs) is an alternative to the standard EMR procedure with a better safety profile, but scientific evidence on its efficacy is unavailable. This study aimed to compare the recurrence rate between the two techniques at 6 months. Secondary aims were comparison of the safety profile and procedure-related outcomes. Methods This was a noninferiority, multicenter, open-label, randomized controlled trial of consecutive large (>= 20 mm) LFNPCLs without suspicious features of submucosal invasion. Results 229 patients were randomized to receive CS-EMR (n = 115) or EMR (n = 114). The median lesion size was 25 mm and 74.6 % were adenomas. The trial was stopped early by clinical consensus according to a safety monitoring board. At first surveillance colonoscopy (n = 220) the recurrence rate was significantly greater in the CS-EMR group than in the EMR group: 33.0 % vs. 16.2 % (P = 0.004) and 34.7 % vs. 14.8 % (P = 0.001) in the intention-to-treat and per-protocol analyses, respectively. According to the subgroup analysis, the recurrence rate was significantly greater after CS-EMR for LFNPCLs >= 30 mm (43.1 % vs. 18.2 %). There was no difference in the rate of adverse events. The use of clips was more common in the EMR group (52.6 % vs. 27.8 %). Conclusions The recurrence rate of LFNPCLs after CS-EMR was significantly greater than after the standard hot technique. A similar safety profile was found between groups.

Keywords

CanceEmrEuropean-societyJapanese societyPolypectomyPolyps

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The work has been published in the journal Endoscopy due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2025, it was in position 2/312, thus managing to position itself as a Q1 (Primer Cuartil), in the category Surgery. Notably, the journal is positioned above the 90th percentile.

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