Comparing precutting endoscopic mucosal resection using snare-tip and ESD knife for large nonpedunculated colorectal polyps: a randomized controlled trial.

Background: Precutting endoscopic mucosal resection (EMR-P) is a modified EMR method for the resection of large non-pedunculated colorectal polyps. In EMR-P, a mucosal incision is made using a snare-tip or endoscopic submucosal dissection (ESD) knife. However, there are concerns that the snare-tip may have a lower procedural success rate than the ESD knife. We aimed to assess the efficacy and safety of EMR-P using a snare-tip compared with that using an ESD knife for large non-pedunculated colorectal polyps.

Methods: Large non-pedunculated colorectal polyps (15-25 mm) were randomly allocated to either the snare-tip or ESD knife EMR-P group. The primary outcome was the en bloc resection rate.

Results: Resection was performed using a snare-tip or ESD knife in 53 patients each. In the intention-to-treat population, the en bloc resection rates for the snare-tip and ESD knife EMR-P groups were not significantly different (98.1% vs. 98.1%, P=1.000). The R0 resection rate in the snare-tip group was not significantly different from that in the ESD knife group (88.7% vs. 92.5%, P=0.663). The total procedure time was 8.9 min (interquartile range [IQR], 7.5-10.3) and 9.3 min (IQR, 7.2-10.9) in the snare-tip and ESD knife groups, respectively (P =0.550). The local recurrence rate was 0% in both groups. No perforations were observed in either group.

Conclusions: EMR-P using a snare-tip was non-inferior to EMR-P using a ESD knife for large non-pedunculated colorectal polyps. EMR-P using a snare-tip is considered as effective and safe as an ESD knife.