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

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

Autores: 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

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Resumen

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.

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