3500 Argon plasma coagulation assisted resection of large sessile colonic polyps: a randomised trial.

Abstract

BACKGROUND: Large sessile adenomas account for up to 3.7% of polyps found at colonoscopy. Removal by piecemeal snare excision and EMR techniques is widely practised, but recurrence is reported in up to 28%, probably because of residual foci of adenoma tissue. AIMS: To evaluate the safety and efficacy (recurrence rate) of APC when combined with piecemeal resection of large sessile polyps. METHODS: Consecutive patients with large sessile polyps requiring piecemeal resection were placed into two groups depending on the endoscopist's assessment of completeness of excision. If complete excision was not possible with the snare alone, APC was applied. If complete excision was achieved, the patient was randomised to APC or no-APC. The procedures were performed by 2 experienced endoscopists (BPS & CBW). APC was set at 65W power, and applied to the polypectomy base and margin. Patients were contacted at 2 weeks, and followed up endoscopically at 6-12 weeks and 1 year. At follow-up, biopsies were taken from the polypectomy site and any recurrent adenoma was resected and treated with APC. RESULTS: 13 patients have had at least one follow up endoscopy, table 1. At initial polypectomy 5 had minor procedural bleeding (3 in APC patients) which settled with topical adrenaline (3) or spontaneously (2). 1 patient had minor bleeding and another had fever for 24 hours after APC had been used for recurrence at follow up. There were no major complications. No polyps have needed surgical excision. CONCLUSIONS: APC appears safe and may help to reduce recurrence of large sessile polyps after piecemeal resection.