Higher recurrence rates with cold snare EMR than with conventional EMR

Cold snare (CS) endoscopic mucosal resection (EMR) led to a higher recurrence rate than conventional EMR in participants with large, non-pedunculated colonic lesions, according to the data of a randomised controlled trial. The effect was particularly evident in lesions with serrated histology or those larger than 30 mm.

“No randomised trials have been performed to compare CS-EMR with conventional EMR for the resection of non-pedunculated lesions without signs of invasiveness,” said Dr Óscar Nogales (Hospital General Universitario Gregorio Marañón, Spain) [1]. Therefore, Dr Nogales and colleagues designed a trial (NCT04418843) to compare the efficacy of both techniques, measured as the absence of recurrence at 6 months. Participants with consecutive non-pedunculate lesions with adenoma or serrated histology with sizes ≥20 mm (n=229) were randomised to CS-EMR or conventional EMR in a 1:1 ratio.

At 6 months, the recurrence rate was significantly higher in participants in the CS-EMR arm than in those who underwent the standard treatment (33.6% vs 16.7%; P=0.007). A subgroup analysis revealed that this effect was particularly present in serrated lesions (34.4% vs 4.2%) and lesions larger than 30 mm (44% vs 19%). “Adverse events were low overall,” added Dr Nogales. No significant differences were found between the 2 arms with respect to delayed bleeding, perforation, post-EMR fever, or post-polypectomy syndrome.

In conclusion, CS-EMR does not appear to be a feasible alternative to conventional EMR in patients with large, non-pedunculate colonic lesions.

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   1. Nogales Ó, et al. Recurrence in large non-pedunculated colonic lesions is significantly higher after cold snare endoscopic mucosal resection than after the standard technique. Results of a randomised controlled trial. LB07, UEG Week 2023, 14–17 October, Copenhagen, Denmark.

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Posted on 7 December 20237 December 2023