Episode Details

Kaltschlingenresektion für große Colonpolypen – Neuigkeiten von der UEGW

Abstracts der beiden präsentierten Studien LB06 COLD VS. HOT SNARE RESECTION OF NON-PEDUNCULATED POLYPS ≥2CM IN THE COLORECTUM – FIRST RESULTS FROM THE PROSPECTIVE, RANDOMIZED, CONTROLLED, MULTICENTRIC CHRONICLE-TRIAL

I. Steinbrück1, A. Ebigbo2, A. Küllmer3, K. Kouladouros4, A. Meining5, T. Koenen6, V. Rempel7, A. Wannhoff8, S. Faiss9, O. Pech10, O. Möschler11, F.L. Dumoulin12, M.M. Kirstein13, T. von Hahn14, H.-D. Allescher15, S. Gölder16, M. Götz17, S. Hollerbach18, B. Lewerenz19, A. Schmidt20, S. Nagl2, S. Belle4, M. Brand5, J. Tischendorf6, K. Caca8, M. Mende9, L. Pfeifer10, V. Weigart15, F. Wiedbrauck18, H. Messmann2, H.-P. Allgaier1 1Evangelisches Diakoniekrankenhaus Freiburg, Department of Medicine and Gastroenterology, Freiburg, Germany, 2Universitätsklinikum Augsburg, Department of Gastroenterology, Augsburg, Germany, 3University of Freiburg, Faculty of medicine, Department of Medicine II, Medical Center, Freiburg, Germany, 4Universitätsmedizin Mannheim, Zentrale Interdisziplinäre Endoskopie, Mannheim, Germany, 5University of Würzburg, Gastroenterology, Würzburg, Germany, 6Rhein-Maas Klinikum Würselen, Department of Internal Medicine and Gastroenterology, Würselen, Germany, 7St. Anna Hospital, Klinik für Gastroenterologie, Herne, Germany, 8RKH Klinikum Ludwigsburg, Department of Gastroenterology, Ludwigsburg, Germany, 9Sana Klinikum Lichtenberg, Department of Gastroenterology, Berlin, Germany, 10Krankenhaus Barmherzige Brüder Regensburg,, Department of Gastroenterology and Endoscopy, Regensburg, Germany, 11Marienhospital Osnabrück, Department of Endoscopy and Ultrasound, Osnabrück, Germany, 12Gemeinschaftskrankenhaus Bonn, Department of Medicine and Gastroenterology, Bonn, Germany, 13University Hospital Lübeck, Department of Medicine I, Lübeck, Germany, 14Asklepios Klinik Barmbek, Department of Gastroenterology, Hepatology and Endoscopy, Hamburg, Germany, 15Klinikum Garmisch-Partenkirchen, Department of Gastroenterology, Garmisch-Partenkirchen, Germany, 16Ostalb-Klinikum Aalen, Department of Internal Medicine I, Aalen, Germany, 17Klinikum Sindelfingen-Böblingen, Department of Gastroenterology/Oncology, Böblingen, Germany, 18AKH Celle, Gastroenterology, Celle, Germany, 19Klinikum Traunstein, Department of Gastroenterology and Hepatology, Traunstein, Germany, 20Robert-Bosch-Krankenhaus, Department of Gastroenterology, Hepatology and Endocrinology, Stuttgart, Germany

Introduction: For the removal of diminutive colorectal polyps <10mm cold snare (CS) resection is standard of care. For polyps ≥20mm endoscopic mucosal resection (EMR) with a hot snare (HS) is recommended, which is usually accomplished in piece meal technique1. Recently, a retrospective trial showed a favorable safety profile and a comparable recurrence rate for CS-EMR in comparison to HS-EMR for sessile serrated adenomas (SSA) ≥20mm2. We investigated if CS-EMR is superior to HS-EMR for the removal of larger, non-pedunculated, colorectal polyps. Aims & Methods: In this prospective, randomized, controlled trial non-pedunculated colorectal polyps ≥20mm were randomly assigned to CS-EMR or HS-EMR. Primary endpoint was major complication (=perforation or clinically significant post-endoscopic bleeding (CSPEB)), secondary endpoints were intraprocedural bleeding (IPB), postpolypectomy syndrome (PPS), technical success, resection speed and recurrence rate after 4 months. Results: 394 polyps were finally enrolled for intention-to-treat analysis. Rates of major complication were significantly lower in the CS-EMR group with 1.0% vs. 8.0% (p=0.001) including rates of perforation of 0% vs. 4.0% (p=0.007) and rates of CSPEB of 1.0% vs. 4.5% (p=0.038). Independent predictor for major complication in uni-/multivariable regression analysis was polyp size (OR 1.10)