Commentary

Local recurrence after piecemeal endoscopic mucosal resection (EMR) is common and it is a major drawback of this technique. Thermal ablation of resection margins after EMR using snare-tip soft coagulation has been shown to decrease the risk of local recurrence in a randomized trial [1]. Hybrid argon plasma coagulation (hAPC) is an alternative ablation technique that can be used to perform margin ablation. Recent studies on hAPC for post-EMR margin ablation showed low rates of local recurrence.

Although the use of hAPC for margin ablation after EMR is a promising technique to reduce the risk of local recurrence, the technique has not been standardized which may limit its use in routine endoscopic practice. In addition, further studies are required to assess the efficacy, safety, and cost–effectiveness of hAPC in a large cohort of patients and compare it with snare-tip soft coagulation.

Regardless of which thermal ablation technique is used, piecemeal EMR is still not an optimal technique for colorectal lesions with risk factors for submucosal superficial invasion (e. g. depressed component, complex morphology [0–Is or 0–Is + IIa], JNET type 2B, and type V pit pattern). Such lesions should be managed by en bloc resection for accurate oncologic assessment. In addition, for selected early colorectal cancers, en bloc and R0 resection, usually by endoscopic submucosal dissection for large-size lesions, may obviate the need for subsequent surgery.

Publication History

Article published online:
29 March 2023

• References

• 1 Klein A, Tate DJ, Jayasekeran V. et al. Thermal ablation of mucosal defect margins reduces adenoma recurrence after colonic endoscopic mucosal resection. Gastroenterology 2019; 156: 604-613e3