PTH-042 Spiral snare resection and hybrid endoscopic mucosal ablation: a comparison of outcomes after piecemeal resection/ablation

Abstract

Introduction Incomplete endoscopic removal of colorectal polyps causes severe submucosal fibrosis, making subsequent endoscopic resection challenging. Two approaches to removal of recurrent polyp over a scarred submucosa or to polyps with inherent submucosal fibrosis such as NG-LST’s are either to use a stiff braided snare which helps capture tissue or to firstly snare as much tissue as possible using a conventional snare and then destroy tissue over the centre of the scar with high power APC preceded by submucosal injection (Endoscopic Mucosal Ablation, EMA). Method A prospective database (Jan 2010–Aug 2012) was used to identify large (>2 cm) colorectal polyps removed in a piecemeal fashion using either hybrid EMR/EMA technique or spiral snare EMR (SS-EMR, Olympus, Keymed, UK) at our tertiary referral centre. Patient/polyp/technique-related details and short/long term endoscopic surveillance data were retrieved and analysed (chi-square/Fischer’s). The aim of this study was to compare the safety, technical success and recurrence between each group (group A – hybrid EMR/EMA, group B – SS-EMR). Results This study enrolled 56 patients in group A and 48 patients in group B. Median polyp size was 3 cm (range 2–8 cm) for group A and 5 cm (2–15 cm) for group B. The majority (64.28%) of polyps in group A had previous failed polypectomy attempts compared to only 27% of polyps in group B. There was no difference in time taken to complete the procedure between the groups (mean time for group A – 36 min vs group B – 39 min). Procedural bleeding (A vs B were 7.1% vs 18.8% p = 0.13) and delayed bleeding (A vs B were 19.6% vs 37.5%, p = 0.05) were more common in group B. There were no peforations in either group. Two (4.2%) patients in SS-EMR group developed post polypectomy syndrome and needed brief hospital admission. Four (7.1%) patients in hybrid EMR/EMA cohort developed delayed bleeding requiring admission for transfusion; all made an uneventful recovery. There was no significant difference in polyp recurrence at 24 months between the groups (A vs B 12.5% vs 8.3%, p = 0.44). No patients have required surgery to date. Conclusion Spiral snare resection and hybrid mucosal resection/ablation modalities are both safe and feasible to eradicate recurrent fibrotic colorectal polyps. Delayed bleeding overall is significantly lower when using the hybrid resection/ablation technique though may be more severe when it does occur. Medium term outcomes appear similar in both groups with acceptable levels of endoscopically manageable recurrence. Disclosure of interest None Declared.