Prophylactic Double Thermal Ablation and Complete Closure After Endoscopic Mucosal Resection of Large Non-Pedunculated Colorectal Polyps: A Randomized Controlled Trial
Large (≥20mm) colorectal polyps often harbor areas of advanced neoplasia, making them immediate colorectal cancer (CRC) precursors. Such polyps have to be completely removed to prevent CRC and to avoid surgery and/or adjuvant therapy. The laterally spreading lesions (LSLs) are removed via endoscopic mucosal resection (EMR). However, recurrence is common. Recent studies have found that the use of hybrid argon plasma coagulation (h-APC) for the ablation of the margin and base of resection post-EMR could significantly reduce the recurrence rate, and complete closure of the post-EMR defect can prevent other adverse pre- and post-procedure outcomes such as bleeding.

We hypothesize that performing hybrid argon plasma coagulation (h-APC) margin and base ablation post-EMR for large (≥20mm) colorectal LSLs will demonstrate a lower recurrence rate compared to Snare Tip Soft Coagulation (STSC) margin ablation. We also hypothesize that performing complete closure of the EMR defect will result in lower rates of adverse events compared to cases where no defect closure is performed.
- EligibilityCriteria: Inclusion Criteria:  adult ≥18 years old patients undergoing EMR for a large (≥20mm) colorectal LSL patients providing written and informed consent for study participation.  Exclusion Criteria:  inflammatory bowel disease; non-elective colonoscopy; poor general health (American Society of Anesthesiologists classification >III); coagulopathy or thrombocytopenia (international normalized ratio ≥1.5 or platelets <50 x 109/L); pedunculated polyps (Paris class Ip, Isp); overt signs of deep submucosal invasive cancer (JNET 3); biopsy proven invasive carcinoma in a potential study polyp. - HealthyVolunteers: No - Gender: All - MinimumAge: 18 Years - StdAgeList: Adult, Older Adult