Abstract
Endoscopic mucosal resection (EMR) is a safe, effective, and surgery-sparing technique for removing large colorectal lesions [1]. Although piecemeal EMR is recommended for polyps > 20 mm in size, it remains a suboptimal technique for complete lesion resection, with high rates of residual polyp and recurrence rates reaching 15 % [2]. Hybrid argon plasma coagulation (hAPC) is a novel approach allowing ablation of resection margins and surface after EMR. hAPC combines waterjet injection and argon plasma coagulation (APC) in a single device. On-demand, repeatable saline cushioning without instrument exchange reduces thermal ablative insult to deep tissue structures, allowing for effective destruction of micro-remnants with reduced risk of perforation. High technical success and low recurrence rates (0 %) were shown in a pilot study using EMR in combination with hAPC [3]. A prospective international multicenter study showed that the local recurrence rate was only 2.2 % when using hAPC after EMR [4]. One recent meta-analysis found the local recurrence rate to be 3.3 % after hot EMR and margin ablation at 12-month follow-up [5].
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