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Expanding Cold EMR to Large Laterally Spreading Lesions

Douglas K. Rex, MD, FASGE, reviewing Mangira D, et al. Gastrointest Endosc 2020 Jan 15.

In 5 Australian academic hospitals, cold EMR was performed on 204 polyps ≥20 mm in 186 patients. Exclusions were any suspicion of submucosal invasion, any lesion with a 1s component >10 mm, pedunculated polyps, active or quiescent colitis, and rectal lesions. Sixty-six percent of the lesions were sessile serrated lesions.

There was follow-up at 6 months in 80.4% of polyps, in which the recurrence rate (about half had biopsies of the scar) was 5.5%. Recurrences were treated primarily with cold techniques. A multivariable analysis did not show any variables independently associated with recurrence except cecal location. In 155 lesions with a normal first follow-up, 3.5% showed a recurrence in a second examination. Serrated histology was not associated with recurrence.

COMMENT
The importance of this study is that it helps extend cold EMR to lesions ≥20 mm and, specifically, to a group of adenomas ≥20 mm. It’s important to note that rectal lesions, lesions with a significant 1s component, and lesions with a high risk of cancer were excluded. The authors clearly favored inclusion of epinephrine, though it was not used in all cases. Randomized controlled trials of cold versus hot EMR are important to organize.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

Douglas K. Rex, MD, FASGE

CITATION(S)

Mangira D, Cameron K, Simons K, et al. Cold snare piecemeal endoscopic mucosal resection of large sessile colonic polyps ≥20 mm (with video). Gastrointest Endosc 2020 Jan 15. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2019.12.051)

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