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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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Conditions de participation

  • Sexe:

    ALL

  • Âges admissibles:

    18 to 89

Critères de participation

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.

Lieu de l'étude

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

Contactez l'équipe d'étude

Primary Contact

Daniel von Renteln, MD

Backup Contact

Julie Fleury

[email protected]
5148908000
Étude parrainée par
Centre hospitalier de l'Université de Montréal (CHUM)
Participants recherchés
Plus d'informations
ID de l'étude: NCT04015765