HOT VS COLD EMR FOR THE TREATMENT OF SESSILE COLORECTAL LESIONS OVER 10 MM

Aims We aim to compare cold and hot snare endoscopic mucosal resection (CSP-EMR, HSP-EMR) in the management of sessile and flat colorectal polyps larger than 10 mm.

Methods Analysed data included endoscopic procedures from January 2019 to December 2020. A total of 164 polypectomies of flat lesions were performed in 108 patients. Lesions were classified according to Paris and J-NET classifications. Both techniques consisted of submucosal injection, followed by en bloc or piece-meal resection. Technical success was defined as complete endoscopic resection. Efficacy was established as the absence of local occurrence during the first follow-up colonoscopy. Adverse events following the procedures were collected and analysed.

Results 79 lesions (in 51 patients) were treated with HS-EMR and 85 lesions (in 57 patients) with CS-EMR. The average polyp size was 17.0 mm in the CS group and 18.5 mm in HS group (p>0.05). Technical success was achieved in 100% in the hot snare and 98.8% in CS-EMR (p>0.05). Local recurrence was detected in 3.52% (3 lesions) after CS-EMR and in 5.06% (4 lesions) after HS-EMR (p>0.05). No perforation was observed in the two groups. Delayed bleeding was observed in two cases (2.53%) in the HS group, no bleeding was encountered in the CS group (p>0.05). Post-polypectomy syndrome occurred in 0.57% in the CS and 7.8% in the HS group (p<0.05).

Conclusions CS-ERM may have similar efficacy to HS-EMR in the treatment of sessile and flat lesions over 10 mm. CS-EMR is a safe treatment option and may offer certain advantages regarding adverse events.

Publication History

Article published online:
14 April 2022