Prevention and treatment of recurrence after endoscopic resection of large non-pedunculated colorectal polyps

Abstract

Minimally invasive endoscopic resection techniques are the recommended first-line treatment strategy for the majority of large non-pedunculated colorectal polyps, with endoscopic mucosal resection (EMR) as a predominant resection modality due to its efficacy, efficiency, safety, and cost-effectiveness. A limitation of EMR is recurrence, which has historically occurred in 15%-20% of lesions. In the past 10 years, a number of effective mitigating strategies have been developed, including margin thermal ablation using snare-tip soft coagulation, argon plasma coagulation (APC), and hybrid-APC, alongside margin marking pre-resection. Moreover, techniques for effective recurrence management have also been developed. Herein, we appraise existing evidence on the frequency of recurrence, reasonings behind recurrence formation, as well as recurrence mitigating strategies and the effectiveness of recurrence management.

Keywords: Adenoma; Cancer; Colonoscopy; Endoscopy; Polyp.

Figure 1

Schematic diagram of different resection, recurrence prevention, and recurrence treatment techniques for large non-pedunculated colorectal polyps.

Figure 2

Snare-tip soft coagulation. A: Post-endoscopic mucosal resection (EMR) defect; B: Snare-tip soft coagulation (STSC); C: Post-EMR defect status post-STSC.

Figure 3

Hybrid-argon plasma coagulation. A: Thermal ablation of the margin of the defect using hybrid-argon plasma coagulation (h-APC); B: Thermal ablation of the base of the defect using h-APC; C: Resection defect after h-APC completed.

Figure 4

Margin marking. A: Snare tip used to mark around the lesion margin; B: Completed margin marking, pre-resection; C: Resection defect.