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Hybrid-APC Margin Ablation to Prevent Post EMR Adenoma Recurrence

Colorectal Cancer | Polyp of Colon

Endoscopic Mucosal Resection (EMR) is the current standard for effective endoscopic resection of such colon adenomas. If resection is possible in one piece (so-called "en bloc" resection) then recurrence rates are low. However, most non-pedunculated polyps \>2 cm are removed in pieces ("piece-meal" resection) which leads to disease recurrence rates between 12-30%. In the March 2019 issue of Gastroenterology Bourke et al. presented that post-EMR ablation of the resection margins using soft coagulation with the tip of a resection snare reduces adenoma recurrence to 5% compared to 21% recurrence found in the control group. Hybrid Argon Plasma Coagulation (h-APC) combines an ablation technique (APC) with the option for submucosal saline injection using a high-pressure water jet. The technique allows to lift of dysplastic epithelium thus creating a safety cushion under the mucosa is lifted with a saline injection and then to ablate larger areas more thoroughly and with a higher energy setting, with a low risk for side effects or complications.

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Participation Requirements

  • Sex:

    ALL

  • Eligible Ages:

    18 to 89

Participation Criteria

Inclusion Criteria:

* All Ethnicity and race; Patient referred for endoscopic resection of all colorectal polyps non-pedunculated equal or greater 20 mm ; Written informed consent

Exclusion Criteria:

* Patients with known (biopsy proven) invasive carcinoma in a potential study polyp; Previous partial EMR; Pedunculated polyps (as defined by Paris Classification type Ip or Isp); Patients with ulcerated depressed lesions (as defined by Paris Classification type III); Patients with inflammatory bowel disease; Patients who are receiving an emergency colonoscopy; Poor general health (ASA class\>3); Patients with coagulopathy with an elevated INR ≥1.5, or platelets \<50; Poor bowel preparation (Boston bowel prep score ≤2); Target sign or perforation during initial EMR; Need for ESD for complete resection prior to APC, Pregnancy and breast-feeding.

Study Location

Centre Hospitalier Universitaire de Montréal (CHUM)
Centre Hospitalier Universitaire de Montréal (CHUM)
Montréal, Quebec
Canada

Contact Study Team

Primary Contact

Daniel von Renteln, MD

Backup Contact

Julie Fleury

[email protected]
5148908000
Study Sponsored By
Centre hospitalier de l'Université de Montréal (CHUM)
Participants Required
More Information
Study ID: NCT04015765