Cold EMR safer than hot EMR for large duodenal adenomas: BMJ
Italy: Cold snare endoscopic resection is safe as compared to a historical cohort of hot technique in a retrospective cohort of large duodenal adenomas, says a recent article published in the BMJ journal Gut. The study found no serious adverse events with cold snaring versus the hot snare group. Also, procedural time was substantially reduced.
Previous studies have shown that for large (>20 mm), sporadic non-ampullary duodenal adenomas, conventional endoscopic mucosal resection using electrocoagulation (hot EMR) is associated with a high complication rate. Antonio Capogreco, IRCCS Humanitas Research Hospital, Rozzano, Italy, and colleagues, therefore, aimed to compare the outcomes of cold and hot endoscopic mucosal resection (EMR) for nonampullary duodenal adenomas >20 mm in a retrospective study.
For this purpose, the researchers performed a retrospective analysis comparing 33 patients treated this way to 101 patients who had hot EMR for their duodenal adenomas based on favorable colonic experience with cold EMR/without electrocautery. Data collection was done from four tertiary centers in two time periods.
Key findings of the study include:
- No serious adverse events (SAEs) occurred in the cold group, there were 17 intraprocedural SAEs (16.8%) and 26 postprocedural SAEs (25.7%) in the hot EMR group.
- Procedure time was significantly lower for cold EMR (49±25.1 min vs 96.9±56 min).
- Recurrence seen at first follow-up endoscopy was comparable in both groups (cold EMR: 12.1% versus hot EMR: 20.8%).
The researchers conclude, "our findings suggest that cold EMR is a safe and feasible option for the removal of large non-ampullary duodenal adenomas.
"This indicates that the implementation of cold snaring may substantially affect the safety of endoscopic resection of non-ampullary duodenal lesions without indirect signs of invasive cancer," the researchers wrote. "The very low incidence of adverse events may also reduce the intensity of care that is routinely required to remove duodenal lesions."
Reference:
Repici A, Capogreco A, Marco S, et alCold versus hot EMR for large duodenal adenomasGut Published Online First: 04 July 2022. doi: 10.1136/gutjnl-2022-327171
