Hybrid APC Assisted EMR for Large Colon Polyps to Reduce Local Recurrence, a Prospective Data Collection Study

ABSTRACT

INTRODUCTION: Large polyps >20 mm make up 5% of all polyps removed and are considered high-risk precancerous lesions. Endoscopic mucosal resection (EMR) is a technique used to remove these polyps, but has a local recurrence rate of 10-30% at first follow up. Recurrence is thought to be due to residual microscopic disease at the edge or base of the resected polyp. Hybrid argon plasma coagulation (APC) is an innovative technique which can be used to ablate the remaining microscopic disease at the base and edge of the polyp thereby reducing local recurrence. The aim of this study was to assess recurrence at 6 months following hybrid APC assisted EMR. Secondary endpoints including post polypectomy bleeding and post polypectomy syndrome were also assessed. METHODS: Patients in this single-center, prospective data collection study were referred to our institution for resection of polyps >20 mm. After obtaining consent, eligible patients underwent endoscopy using the hybrid APC assisted EMR technique. Participants were contacted 30 days after their procedure to assess adverse events. At 6 months, patients were brought back in for a surveillance colonoscopy, and rate of polyp recurrence was calculated. This study was approved by the Penn State Institutional Review Board. RESULTS: At the time of this report, 25 (62.5%) of the 40 treated patients had completed the 6-month follow-up colonoscopy. Three patients were lost to follow up, one patient withdrew for personal reasons, and 11 patients are currently awaiting rescheduling due to the COVID-19 pandemic. Demographics of the included patients and characteristics of the study polyps are displayed in Table 1 and Table 2, respectively. Post polypectomy bleeding was reported by 3 (7.5%) patients, and post polypectomy syndrome was reported by 1 (2.5%) patient. None of the 25 patients who have completed the study showed recurrence at 6 months. CONCLUSION: This prospective data collection study assessing 6-month recurrence rate using hybrid APC assisted EMR preliminarily resulted in a 0% local recurrence rate. Secondary end points assessing post polypectomy syndrome and post polypectomy bleeding revealed an incidence of 2.5% and 7.5%, respectively. This suggests that hybrid APC assisted EMR may be more effective at reducing the rate of polyp recurrence. Additional studies assessing a larger population of patients in a randomized control trial would be recommended to ensure this data is generalizable to the general population.