Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana.
Division of Gastroenterology and Hepatology, NYU Langone Medical Center, New York, New York.
Clin Gastroenterol Hepatol. 2024 Mar;22(3):552-561.e4. doi: 10.1016/j.cgh.2023.09.041. Epub 2023 Oct 21.
BACKGROUND & AIMS: Thermal treatment of the defect margin after endoscopic mucosal resection (EMR) of large nonpedunculated colorectal lesions reduces the recurrence rate. Both snare tip soft coagulation (STSC) and argon plasma coagulation (APC) have been used for thermal margin treatment, but there are few data directly comparing STSC with APC for this indication.
We performed a randomized 3-arm trial in 9 US centers comparing STSC with APC with no margin treatment (control) of defects after EMR of colorectal nonpedunculated lesions ≥15 mm. The primary end point was the presence of residual lesion at first follow-up.
There were 384 patients and 414 lesions randomized, and 308 patients (80.2%) with 328 lesions completed ≥1 follow-up. The proportion of lesions with residual polyp at first follow-up was 4.6% with STSC, 9.3% with APC, and 21.4% with control subjects (no margin treatment). The odds of residual polyp at first follow-up were lower for STSC and APC when compared with control subjects (P = .001 and P = .01, respectively). The difference in odds was not significant between STSC and APC. STSC took less time to apply than APC (median, 3.35 vs 4.08 minutes; P = .019). Adverse event rates were low, with no difference between arms.
In a randomized trial STSC and APC were each superior to no thermal margin treatment after EMR. STSC was faster to apply than APC. Because STSC also results in lower cost and plastic waste than APC (APC requires an additional device), our study supports STSC as the preferred thermal margin treatment after colorectal EMR. (Clinicaltrials.gov, Number NCT03654209.).
内镜下黏膜切除术（EMR）后对大的无蒂结直肠病变的缺陷边缘进行热治疗可降低复发率。套扎尖端软凝固（STSC）和氩等离子凝固（APC）均已用于热边缘治疗，但直接比较 STSC 与 APC 用于该适应证的资料很少。
我们在美国 9 个中心进行了一项随机 3 臂试验，比较了 EMR 切除≥15mm 的结直肠无蒂病变后，对缺陷边缘进行 STSC 与 APC 与无边缘处理（对照）的效果。主要终点是首次随访时是否存在残留病变。
共纳入 384 例患者和 414 处病变，308 例患者（80.2%）的 328 处病变完成了至少 1 次随访。首次随访时残留息肉的比例分别为 STSC 组 4.6%、APC 组 9.3%和对照组（无边缘处理）组 21.4%。与对照组相比，STSC 和 APC 治疗时首次随访时残留息肉的可能性更低（P=.001 和 P=.01）。STSC 和 APC 之间的优势差异无统计学意义。STSC 应用时间短于 APC（中位数 3.35 比 4.08 分钟；P=.019）。各治疗组不良事件发生率均较低，组间无差异。
在一项随机试验中，STSC 和 APC 均优于 EMR 后无热边缘处理。STSC 比 APC 应用更快。由于 STSC 比 APC 还可降低成本和塑料废物（APC 需要额外的设备），因此我们的研究支持 STSC 作为结直肠 EMR 后首选的热边缘处理方法。（Clinicaltrials.gov，编号 NCT03654209.）。
