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

Abstract

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.

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

“…A recent multicenter three-arm randomized controlled trial (RCT) on 384 patients by Rex et al, comparing APC, STSC, and placebo, found superiority of thermal ablation compared to placebo [ 16 ]. Prior systematic reviews and meta-analyses have shown the efficacy and safety of thermal ablation modalities [ 18 , 19 , 20 ]. However, no updated network meta-analysis incorporating an RCT has been performed to draw comparison between these three modalities.…”