P0179 - Adoption and Outcomes of Mucosal Defect Margin Snare Tip Soft Coagulation Following Piecemeal Endoscopic Mucosal Resection

Kurren A. Mehta, MD¹, Daniel Weinberg, MD², Joshua Lee, MD¹, Donna Niedzwiecki, PhD³, Joshua P. Spaete, MD^1
1Duke University Medical Center, Durham, NC; ²Duke University Hospital, Durham, NC; ³Duke University School of Medicine, Durham, NC

Introduction: Endoscopic mucosal resection (EMR) is the preferred technique for removal of large non-pedunculated polyps. Prior studies have shown a decrease in adenoma recurrence rate with snare tip soft coagulation (STSC) of the mucosal defect margin after piecemeal EMR, and recent multi-society guidelines recommend adoption of this technique. We evaluated the adoption of STSC following piecemeal EMR by different endoscopy groups at a tertiary medical center before and after the updated guidelines. We also evaluated subsequent adenoma recurrence rates.

Methods: We retrospectively reviewed 1604 patients undergoing EMR at our tertiary medical center between 3/2017 and 3/2021. Those with adenomatous polyps ≥ 15mm completely resected via piecemeal EMR were included. The primary outcome was recurrence at first surveillance with and without STSC margin ablation. Rates of adoption of STSC amongst groups of endoscopists (advanced endoscopy, large polyp, and general) were also analyzed.

Results: Of the 465 patients who met inclusion criteria, 337 patients (72.5%) had a surveillance colonoscopy (mean 7.1 months, SD 5.2). There was a significant difference observed in the proportions of patients with recurrence at 6 months between polyps treated with and without STSC of the margin (26.2% vs. 42.7%; p=0.048). 334 patients (72%) underwent polypectomy before publication of the multi-society guidelines in 3/2020, and 131 (28%) had resection after publication. Performance of STSC after piecemeal EMR differed significantly by endoscopist type both before and after the multi-society guidelines were published (p< 0.001, before and after). General endoscopists used STSC at a lower rate than endoscopists with advanced or large polyp training in both time periods.

Discussion: In this retrospective cohort study, we found that adenoma recurrence rates were lower in polyps undergoing STSC margin ablation, which is consistent with prior studies. We also found significant differences among advanced endoscopists, endoscopists trained in large polyp removal, and general endoscopists in the performance of STSC margin ablation. General endoscopists had lower rates of usage. Due to lower recurrence rates with STSC, the training of general endoscopists in this technique is an opportunity for quality improvement in large polyp resection.



Disclosures:


Kurren A. Mehta, MD¹, Daniel Weinberg, MD², Joshua Lee, MD¹, Donna Niedzwiecki, PhD³, Joshua P. Spaete, MD¹. P0179 - Adoption and Outcomes of Mucosal Defect Margin Snare Tip Soft Coagulation Following Piecemeal Endoscopic Mucosal Resection, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.