Systematic Review and Meta-analysis Indicates Snare Tip Soft Coagulation of EMR Margins Is Likely Better Than Argon Plasma Coagulation
Douglas K. Rex, MD, MASGE, reviewing Meulen LW, et al. Endosc Int Open 2022 Jun 3.
Thermal treatment of the margin of piecemeal endoscopic mucosal resection (EMR) defects is now considered an effective treatment for reducing recurrences. Some practitioners have adopted the recent evidence for snare tip soft coagulation (STSC) of the margin, whereas some prefer argon plasma coagulation (APC).
A systematic review and meta-analysis identified 10 studies about thermal ablation of mucosal defect margins, including 3 on APC, 6 on STSC, and 1 comparing both treatments. In total, there were 316 APC cases and 1598 STSC cases. The overall risk of recurrence was reduced by 84% with STSC and 74% with APC, compared with no treatment. Absolute rates of recurrence were 19.6% with no treatment, 9% with APC, and 4% with STSC.
COMMENTA single large randomized trial of STSC dominates this study’s results. According to the only randomized trial comparing APC to STSC, there was no significant difference in recurrence rates. However, there is no evidence that APC is superior to STSC, and the lack of additional cost after snaring using STSC (unlike the cost of the APC catheter) makes STSC the current preferred treatment.
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.
CITATION(S)
Meulen LW, Bogie R, Winkens B, Masclee A, Moons LM. Thermal ablation of mucosal defect margins to prevent local recurrence of large colorectal polyps: a systematic review and meta-analysis. Endosc Int Open 2022 Jun 3. (Epub ahead of print) (https://doi.org/10.1055/a-1869-2446)
