Margin Thermal Ablation Eliminates Size as a Risk factor for Recurrence after Piecemeal Endoscopic Mucosal Resection of Large Non-Pedunculated Colorectal Polyps

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Aims Lesion size is an independent risk factor for recurrence following endoscopic mucosal resection of large (> /=20mm) non-pedunculated colorectal polyps [ 1 ]. Post-resection margin thermal ablation (MTA) reduces the risk for recurrence. Its impact on the uncommon larger (> /=40mm) lesions is unknown. We sought to analyse the impact of MTA on>/=40mm lesions in a large, prospective cohort. Methods A prospective cohort of patients with colorectal polyps>/=20mm treated with piecemeal endoscopic mucosal resection in an expert tissue resection centre was divided into three phases: ‘pre-MTA’; July 2008- June 2012, ‘MTA adoption’; July 2012-June 2017 and ‘standardised-MTA’; July 2017-July 2023. Recurrence was defined as adenomatous tissue endoscopically and/or histologically detected at the first surveillance colonoscopy. The primary outcome was the recurrence rate over the three time periods in three size groups: 20-39mm, 40-59mm and>/=60mm Results Over 14 years until July 2023, 1872 sporadic colorectal polyps>/=20mm in 1872 patients underwent endoscopic mucosal resection (median lesion size 35mm [interquartile range 25-45mm]). Of these, 1349 patients underwent surveillance colonoscopy at a median of 6 months (IQR 4-8 months). The overall rates of recurrence in the pre-MTA, MTA-adoption and standardised-MTA phases were 13.5% (n=42/310), 12.6% (n=72/560) and 2.1% (n=10/479) respectively (p=<0.001). When margin thermal ablation was applied in the standardised-MTA phase, the rate of recurrence was the same amongst 20-39mm (1.5% [3/205]), 40-59mm (1.6% [3/190]) and>/=60mm polyps (1.4% [1/73]) (p=1.00). Conclusions Margin thermal ablation negates the effect of size on the incidence of recurrence after piecemeal endoscopic mucosal resection of colorectal polyps>/=40mm 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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