Hybrid Argon Plasma Coagulation Endorsed to Reduce Recurrence Rate After Colorectal EMR

Hybrid Argon Plasma Coagulation Endorsed to Reduce Recurrence Rate After Colorectal EMR

Douglas K. Rex, MD, MASGE, reviewing Motchum L, et al. Gastrointest Endosc 2022 Jun 17.

Thermal coagulation of the normal-appearing margin using snare tip soft coagulation (STSC) treatment after endoscopic mucosal resection (EMR) has been shown to reduce recurrence rates after piecemeal EMR of large nonpedunculated colorectal polyps to the range of 2% to 5%. Hybrid argon plasma coagulation (H-APC) is a technique combining injection and APC in the same probe. 

In this uncontrolled study, EMR was performed on 101 colorectal lesions with a median size of 30 mm (range, 20-60 mm). Patients underwent H-APC to treat the margin in all cases and, at the discretion of the endoscopist, part or all of the base of the lesion. The recurrence rate at follow-up was 2.2% (2 of 91).

Douglas K. Rex, MD, FASGE


This paper seemed worthy of review because of the very low 2.2% recurrence rate. Beyond that, it is difficult to interpret because it is nonrandomized, and the treatment method was not standardized, with some patients receiving APC treatment to the EMR-defect base. Further, this paper provides no insight into whether the injection component of H-APC provides any advantage over simple APC. A recent systematic review and meta-analysis suggested that STSC was found, across published literature, to be more effective than APC, and STSC, of course, eliminates the need for an expensive APC catheter.

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.


Motchum L, Levenick JM, Djinbachian R, et al. Endoscopic mucosal resection combined with hybrid argon plasma coagulation to prevent recurrence of large nonpedunculated colorectal polyps. Gastrointest Endosc 2022 Jun 17. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2022.06.018)

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