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• W4328050985 abstract "We have read with interest the article by Arisha et al1Arisha M.A. Scapa E. Wishahi E. et al.Impact of margin ablation after endoscopic mucosal resection of large nonpedunculated colonic polyps in routine clinical practice.Gastrointest Endosc. 2023; 97: 559-567Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar and congratulate them on contributing to the growing literature of decreased recurrence after EMR with margin ablation (EMR-T) of laterally spreading tumors (LST, preferred term in literature over LNPCP).2Kandel P. Werlang M.E. Ahn I.R. et al.Prophylactic snare tip soft coagulation and its impact on adenoma recurrence after colonic endoscopic mucosal resection.Dig Dis Sci. 2019; 64: 3300-3306Crossref PubMed Scopus (16) Google Scholar,3Nader S.M. Lahr R.E. Rex D.K. Impact of margin thermal treatment after endoscopic mucosal resection of giant (≥ 40 mm) colorectal lateral spreading lesions.Gastrointest Endosc. 2023; 97: 544-548Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar However, the authors report solely visual recurrence as a primary outcome, leaving out additional cases of histologic recurrence in the primary analysis. Congruent with published literature, it seems that several EMR scars harbored covert histologic recurrence, which could be potentially prevented with the use of dye or optical magnification image-enhanced endoscopy.4Knabe M. Pohl J. Gerges C. et al.Standardized long-term follow-up after endoscopic resection of large, nonpedunculated colorectal lesions: a prospective two-center study.Am J Gastroenterol. 2014; 109: 183-189Crossref PubMed Scopus (110) Google Scholar Reporting the combined outcomes of visual and histologic recurrence for all lesions would have yielded 8% recurrence for EMR-T versus 36% for EMR; however, in the article text and in Table 2 this percentage is not reported. EMR-T recurrence is therefore comparable with that in other studies reporting 9% to 12% recurrence with snare tip soft coagulation with the use of visual and histologic assessment.2Kandel P. Werlang M.E. Ahn I.R. et al.Prophylactic snare tip soft coagulation and its impact on adenoma recurrence after colonic endoscopic mucosal resection.Dig Dis Sci. 2019; 64: 3300-3306Crossref PubMed Scopus (16) Google Scholar,3Nader S.M. Lahr R.E. Rex D.K. Impact of margin thermal treatment after endoscopic mucosal resection of giant (≥ 40 mm) colorectal lateral spreading lesions.Gastrointest Endosc. 2023; 97: 544-548Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar We believe that reporting real-life EMR or endoscopic submucosal dissection (ESD) outcomes should be standardized, reporting all lesions referred for resection, and identifying both visual and histologic recurrence as primary outcomes. Otherwise, derived meta-analyses risk comparing face-value results affected by polyp selection bias and nonstandardized primary outcomes complicating comparisons between snare tip soft coagulation and other ablation techniques such as hybrid argon plasma coagulation, argon plasma coagulation, and underwater/cold-snare EMR.5Motchum L. Levenick J.M. Djinbachian R. et al.EMR combined with hybrid argon plasma coagulation to prevent recurrence of large nonpedunculated colorectal polyps (with videos).Gastrointest Endosc. 2022; 96: 840-848.e2Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar,6Nagl S. Ebigbo A. Goelder S.K. et al.Underwater vs conventional endoscopic mucosal resection of large sessile or flat colorectal polyps: a prospective randomized controlled trial.Gastroenterology. 2021; 161: 1460-14674.e1Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar Going forward, reporting intestinal preservation rates, long-term recurrence beyond first surveillance, and colorectal cancer, especially after piecemeal EMR, is needed to inform the debate on ESD versus EMR techniques as a primary approach for LSTs, as demonstrated in a recent study reporting 5-year outcomes after ESD.7Ohata K. Kobayashi N. Sakai E. et al.Long-term outcomes after endoscopic submucosal dissection for large colorectal epithelial neoplasms: a prospective, multicenter, cohort trial from Japan.Gastroenterology. 2022; 163: 1423-1434.e2Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar Only then can we truly start comparing outcomes between ESD and novel EMR-T techniques. However, these points do not diminish the significant reductions of recurrence with EMR-T while being fast, easy to learn, and safe.8Sidhu M. Shahidi N. Gupta S. et al.Outcomes of thermal ablation of the mucosal defect margin after endoscopic mucosal resection: a prospective, international, multicenter trial of 1000 large nonpedunculated colorectal polyps.Gastroenterology. 2021; 161: 163-170.e3Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar From this perspective, the study adds important information that margin ablation should always follow after EMR. Dr von Renteln is the recipient of research funding from ERBE, Ventage, Pendopharm, Fujifilm, and Pentax and a consultant for ERBE, Pendopharm, and Boston Scientific. The remaining authors disclosed no financial relationships." @default.
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• W4328050985 title "Thermal ablation of the margin defect after EMR: the need for randomized controlled trials with standardized outcome assessment" @default.
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