RecruitingNot ApplicableNCT06271941

Reducing Neoplasia Recurrence After Endoscopic Resection of Large Colorectal Polyps

Sponsor

Centre hospitalier de l'Université de Montréal (CHUM)

Enrollment

892 participants

Start Date

Jul 19, 2024

Study Type

INTERVENTIONAL

Conditions

Colorectal, Cancer Polyp of Colon

Summary

Large (≥20mm) colorectal polyps often harbor areas of advanced neoplasia, making them immediate colorectal cancer (CRC) precursors. Such polyps have to be completely removed to prevent CRC and to avoid surgery and/or adjuvant therapy. The laterally spreading lesions (LSLs) are removed via endoscopic mucosal resection (EMR). However, recurrence is common. New techniques for LSL resection (hybrid argon plasma coagulation (h-APC) margin and base ablation) have shown a reduction in recurrence following the interventions. We hypothesize that performing hybrid argon plasma coagulation (h-APC) margin and base ablation during EMR of large (≥20mm) colorectal LSLs will lead to lower rates of lesion recurrence compared to Snare tip soft coagulation (STSC) margin ablation.

Eligibility

Min Age: 18 Years

Inclusion Criteria3

adult ≥18 years old
patients undergoing EMR for a large (≥20mm) colorectal LSL
patients providing written and informed consent for study participation.

Exclusion Criteria8

inflammatory bowel disease;
non-elective colonoscopy;
poor general health (American Society of Anesthesiologists classification \>III);
coagulopathy or thrombocytopenia (international normalized ratio ≥1.5 or platelets \<50 x 109/L);
pedunculated polyps (Paris class Ip, Isp);
overt signs of deep submucosal invasive cancer (JNET 3);
biopsy proven invasive carcinoma in a potential study polyp.
Pregnant women

Interventions

PROCEDUREHybrid Argon Plasma Coagulation (h-APC)

The hybrid argon plasma coagulation (h-APC) combines an ablation technique (APC) with the option for submucosal saline injection using a high-pressure water jet. The technique allows for the lifting of dysplastic epithelium, creating a cushion under the mucosa to facilitate the ablation of larger areas more thoroughly and with higher energy settings, while posing a low risk for side effects or complications.

PROCEDURESnare tip soft coagulation (STSC)

The Snare tip soft coagulation (STSC) involves using a snare to remove polyps, while simultaneously applying soft coagulation to the surrounding tissue using a specialized tip on the snare.