Complementação por coagulação com plasma de argônio após a ressecção endoscópica completa pela técnica de fatiamento para grandes adenomas colorretais

Albuquerque, Walton; Arantes, Vitor; Coelho, Luiz Gonzaga Vaz; Dias, Carlos Alberto Freitas; Savassi-Rocha, Paulo Roberto

doi:10.1590/s0100-69912013000500010

Cited by 10 publications

(5 citation statements)

References 24 publications

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“…The number of lesions included in the APC studies is very small (Brooker et al n = 21; Albuquerque et al n = 21). Furthermore, the study by Brooker et al showed a recurrence rate of 63.6 % in the control group, which raises the question whether these data are representative for current practice 18 19 . In addition to the studies by Brooker et al and Albuquerque et al, an abstract by Chattree and Rutter (2015) also reported data on the effect of APC on recurrence.…”

Section: Discussionmentioning

confidence: 94%

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Thermal ablation of mucosal defect margins to prevent local recurrence of large colorectal polyps: a systematic review and meta-analysis

et al. 2022

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Background: Endoscopic mucosal resection of large non-pedunculated colorectal polyps is characterized by a high risk of recurrence. Thermal ablation of the mucosal defect margins may reduce recurrence in these lesions, but a systematic overview of the current evidence is lacking. Materials and methods: We searched Pubmed, Embase and Cochrance until July 2021, for studies on thermal ablation of mucosal defect margins of large non-pedunculated colorectal polyps. Main goal of this meta-analysis was to identify pooled risk difference of recurrence between thermal ablation vs. no adjuvant treatment. Secondary goal was to identify pooled recurrence rate after STSC and APC. Results: Ten studies on thermal ablation of mucosal defect margins were included, with 3 studies on argon plasma coagulation, 6 studies on snare tip soft coagulation and 1 study comparing both treatment modalities, representing a total of 316 APC cases and 1598 STSC cases. Overall pooled risk difference of recurrence was -0.17 (95% CI -0.22 – -0.12) as compared to no adjuvant treatment. Pooled risk difference was -0.16 (95% CI -0.19 – -0.14) for STSC and -0.26 (95% CI -0.80 – 0.28) for APC. Pooled recurrence rate was 4% (95%-CI 2-8%) for STSC and 9% (95%-CI 4-19%) for APC. Conclusions: Thermal ablation of mucosal defect margins significantly reduces recurrence rate in large non-pedunculated colorectal lesions compared to no adjuvant treatment. While no evidence for superiority exists, snare tip soft coagulation may be preferred over argon plasma coagulation, because this method is the most evidence-based, and cost-effective modality.

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Section: Discussionmentioning

confidence: 94%

“…Settings for APC show more variation between operators, with currents between 30–70 Watts and a gasflow of 0.8–2.0 liters per min 18 19 24 25 . A recent study in porcine models evaluating the effects of STSC and APC showed that APC applied at 1.0 L/min, 30 W, was associated with islands of preserved mucosa 26 .…”

Section: Discussionmentioning

confidence: 99%

Thermal ablation of mucosal defect margins to prevent local recurrence of large colorectal polyps: a systematic review and meta-analysis

et al. 2022

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“…Using the inclusion/exclusion criteria, a total of 13 studies with 2686 patients were included ( Figure 1 and Table 1 ) [ 12 , 13 , 16 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ]. Two of the studies were published as a single article [ 37 ].…”

Section: Resultsmentioning

confidence: 99%

Efficacy and Safety of Thermal Ablation after Endoscopic Mucosal Resection: A Systematic Review and Network Meta-Analysis

Haghbin,

Zakirkhodjaev,

Fatima

et al. 2024

JCM

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(1) Background: Large colonic polyps during colonoscopy can be managed by Endoscopic mucosal resection (EMR). To decrease the polyp recurrence rate, thermal ablation methods like argon plasma coagulation (APC) and snare tip soft coagulation (STSC) have been introduced. We performed this network meta-analysis to assess the efficacy and safety of these modalities. (2) Methods: We performed a comprehensive literature review, through 5 January 2024, of databases including Embase, PubMed, SciELO, KCI, Cochrane Central, and Web of Science. Using a random effects model, we conducted a frequentist approach network meta-analysis. The risk ratio (RR) with 95% confidence interval (CI) was calculated. Safety and efficacy endpoints including rates of recurrence, bleeding, perforation, and post polypectomy syndrome were compared. (3) Results: Our search yielded a total of 13 studies with 2686 patients. Compared to placebo, both APC (RR: 0.33 CI: 0.20–0.54, p < 0.01) and STSC (RR: 0.27, CI: 0.21–0.34, p < 0.01) showed decreased recurrence rates. On ranking, STSC showed the lowest recurrence rate, followed by APC and placebo. Regarding individual adverse events, there was no statistically significant difference between either of the thermal ablation methods and placebo. (4) Conclusions: We demonstrated the efficacy and safety of thermal ablation after EMR for decreasing recurrence of adenoma.

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“…This was an important finding in EMR because there exist unseen residual neoplastic cells at the margins of the snare trajectory. Intuitively, other interventions targeting the EMR margins have also been introduced in endoscopy practice along with extended EMR 26 , such as precutting EMR 27 , APC 28 29 , and STSC 7 9 . In general, these interventions decrease recurrence rates by as much as 63 % 30 , with APC and STSC demonstrating superior efficacy in recurrence reduction compared to extended EMR and precutting EMR as per subgroup analysis.…”

Section: Discussionmentioning

confidence: 99%

Post-EMR for colorectal polyps, thermal ablation of defects reduces adenoma recurrence: A meta-analysis

et al. 2022

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Introduction Adenoma recurrence is one of the key limitations of EMR which occur in 15% to 30% in first surveillance colonoscopy. The main hypothesis behind adenoma recurrence is due to left over micro-adenomas at the margins of post EMR defects. In this systematic review and meta-analysis, we evaluate the efficacy of snare tip soft coagulation (STSC) at the margins of mucosal defects to reduce adenoma recurrence and bleeding complications. Methods Electronic databases such as PubMed and the Cochrane library were used for systematic literature search. Studies with polyps only resected by piece meal EMR and active treatment: with STSC, comparator: non-STSC were included. Random effects model was used to calculate the summary of risk ratio (RR) and 95% confidence intervals. The main outcome of the study was to compare the effect of STSC versus non-STSC with respect to adenoma recurrence at first surveillance colonoscopy after thermal ablation of post-EMR defects. Results Total five studies were included in systematic review and meta-analysis. Total number patients who completed first surveillance colonoscopy (SC1) in STSC group was 534 and non-STSC group was 514. Pooled adenoma recurrence rate was observed in 37 of 534 cases (6%) in STSC arm and 115 of 514 cases (22%) in non-STSC arm, (RR 0.26, 95% CI, 0.16-0.41, p=0.001). Pooled delayed post EMR bleeding rate was observed in 67/343 (19%) in STSC arm and 78/341 (22%) in non-STSC (RR 0.82, 95% CI, 0.57-1.18). Conclusion Thermal ablation of post EMR defects significantly reduces adenoma recurrence at first surveillance colonoscopy.

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Complementação por coagulação com plasma de argônio após a ressecção endoscópica completa pela técnica de fatiamento para grandes adenomas colorretais

Abstract: Complementation by argon plasma coagulation after apparent complete endoscopic piecemeal resection of large sessile colorectal adenomas does not seem to reduce the occurrence of residual adenomatous lesions or local recurrence.

Cited by 10 publications

References 24 publications

Thermal ablation of mucosal defect margins to prevent local recurrence of large colorectal polyps: a systematic review and meta-analysis

Thermal ablation of mucosal defect margins to prevent local recurrence of large colorectal polyps: a systematic review and meta-analysis

Efficacy and Safety of Thermal Ablation after Endoscopic Mucosal Resection: A Systematic Review and Network Meta-Analysis

Post-EMR for colorectal polyps, thermal ablation of defects reduces adenoma recurrence: A meta-analysis

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