Impact Of Margin Thermal Ablation After Cold-Forceps Avulsion With Snare-Tip Soft Coagulation (CAST) For Non-Lifting Large Non-Pedunculated Colorectal Polyps

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Aims Non-lifting large non-pedunculated colorectal polyps (NL-LNPCPs) account for 15% of LNPCP and are effectively managed by Endoscopic Mucosal Resection with adjunctive Cold-forceps Avulsion with adjuvant Snare-Tip soft coagulation (CAST). Recurrence rates>10% at surveillance colonoscopy is a significant limitation. We sought to evaluate the effect of Margin Thermal Ablation (MTA) on NL-LNPCPs treated by EMR and CAST. Methods Prospective observational data on consecutive patients with NL-LNPCPs treated by EMR and CAST at a single tertiary center was retrospectively evaluated. Two cohorts were established: the pre-MTA period (January 2012-June 2017) and the MTA period (July 2017-October 2023). The primary outcome was the residual/recurrent adenoma (RRA) rate at first surveillance colonoscopy (SC1). Results Over 142 months, 300 patients underwent EMR and CAST for LNPCP: 103 lesions pre-MTA and 197 with MTA. The rate of LNPCPs who had previous biopsies was higher in the MTA cohort than pre-MTA cohort (110 vs 38, 55.8 vs 36.9, p=<0.001). The most common lesion morphology was Paris classification 0-IIa (204 LNPCPs, 68.0%). The MTA group had a higher proportion of granular lesions compared to the pre-MTA group (123 vs. 43, 62.4% vs. 41.7%, p=0.01) At SC1, recurrence rate was lower in the MTA cohort compared to the pre-MTA cohort (5.0% vs. 18.4%, p<0.001). Adverse events were similar between the two cohorts [deep mural injury types III-V (pre-MTA 2.9% vs MTA 5.6%, p=0.29), delayed bleeding (pre-MTA 8.7% vs MTA 7.1%, p=0.49)]. On multivariate analysis, MTA was the only variable independently associated with a reduced likelihood of recurrence (OR 0.20, 95% CI 0.07–0.54; P=0.001). Conclusions For NL-LNPCPs, MTA in combination with CAST is safe and effective and reduces recurrence at SC1 by 80% in comparison to CAST alone. Publication History Article published online: 27 March 2025 © 2025. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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