Published online Jun 21, 2023. doi: 10.3748/wjg.v29.i23.3668
Peer-review started: March 2, 2023
First decision: April 8, 2023
Revised: April 21, 2023
Accepted: May 23, 2023
Article in press: May 23, 2023
Published online: June 21, 2023
Processing time: 105 Days and 23.6 Hours
In endoscopic resection (ER) of colorectal lesions, it is important to develop resection methods that enable efficient and safe resection. Most recently, we have reported in ex vivo porcine model that endoscopic resection using bipolar snare for intermediate size lesions didn’t lead to thermal injury for the intrinsic muscle layer even without submucosal injection. Therefore, the bipolar ER for intermediate size colorectal lesions of 10-15 mm has the potential to provide prominent outcomes in an efficient and highly safe manner even without submucosal injection.
We would like to assess the treatment outcomes of the bipolar resection with and without submucosal injection.
The present study aims to compare the resection results of endoscopic mucosal resection (EMR), which refers to the resection following submucosal injection, and hot snare polypectomy (HSP), which refers to the resection with no submucosal injection, to evaluate the efficacy and safety of HSP with bipolar snare for 10-15 mm lesions.
We conducted the single-centre retrospective analysis of all 10-15 mm size colorectal lesions with a diagnosis of JNET Type 2A and resected by either EMR or HSP from January 2018 to June 2021. The target lesions were divided into two groups, HSP group and EMR group, and treatment outcomes and the adverse events were compared by conducting propensity score matching analysis.
Of the 565 lesions in 463 patients, 117 lesions each in the HSP and EMR groups were selected after propensity score matching. In the original cohort, there was a significant difference in antithrombotic drug use (P < 0.05), lesion size (P < 0.01), location (P < 0.01), and macroscopic type (P < 0.05) between the HSP and EMR groups. In the matched cohort, the en bloc resection rates were 93.2% (109/117) in the HSP group and 92.3% (108/117) in the EMR group, in which there was no significant difference (P = 0.81). Moreover, no significant difference was observed in the R0 resection rate [77.8% (91/117) vs 80.3% (94/117), P = 0.64]. The rates of delayed bleeding were comparable between the groups [1.7% (2/117)]. Perforation occurred in the EMR group [0.9% (1/117)] but not in the HSP group.
Using bipolar snare, ER of nonpedunculated 10–15 mm colorectal lesions may be performed safely and effectively, even without submucosal injection.
A large-cohort, multicentre, prospective, randomized controlled trial is warranted to prove the non-inferiority of bipolar HSP to bipolar EMR in treatment outcomes with ER of nonpedunculated 10–15 mm colorectal lesions.