No difference in risk for severe adverse reactions or recurrence relative to the clinician’s preferred electrosurgical setting was reported among patients who had colorectal polyps removed via endoscopic resection, according to results from a single-blind, randomized trial published in Gastroenterology.

Patients with nonpedunculated colorectal polyps measuring ≥20 mm (N=928) were randomly assigned to undergo endoscopic mucosal resection with the use of either blending and cutting current (Endo Cut® Q [setting effect 2, duration 1, and interval 4; n=464) or pure coagulation current (forced coagulation setting effect 2 at 25 watts; n=464) at 18 US centers between 2013 and 2017. All patients were evaluated after 30 days, and 675 patients underwent colonoscopy for surveillance at approximately 6 months.

Serious adverse effects were reported by 7.2% (n=33) of the Endo Cut group and 7.9% (n=36; P =.686) of the forced coagulation group. The investigators reported no significant difference in the proportion of completely removed polyps between the Endo Cut and forced coagulation groups (96.3%, n=494 vs 94.9%, n=461; P =.267). The same number of patients in both groups (n=61; P =.762) were found to have experienced polyp recurrence at the secondary surveillance.


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The investigators reported a significantly higher amount of intraprocedural bleeding requiring medical intervention in the Endo Cut group (17.4%; n=89) compared with the forced coagulation group (11.3%; n=55; P =.006).

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A limitation of this study is that only 1 setting for either of the currents was tested. The study authors reported that in a survey conducted prior to the study, they found that the Endo Cut 2.1.4 setting was used by endoscopists with the same frequency as the Endo Cut 3.1.6 setting; however, the investigators were unable to incorporate both settings into the present study due to the sample sizes.

The authors concluded that there was no significant difference in risk of serious adverse effects, polyp removal rate, or polyp recurrence between 2 of the commonly used electrosurgical settings employed during resection of large colorectal polyps, and that setting selection should be based on endoscopist preference and expertise.

Disclosure: This study was funded by a research grant from Boston Scientific. Some authors declared receiving consulting or funding from the pharmaceutical industry. A complete list of disclosures can be found in the original study.

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Reference

Pohl H, Grimm IS, Moyer MT, et al. Effects of blended (yellow) vs forced coagulation (blue) currents on adverse events, complete resection, or polyp recurrence after polypectomy in a large randomized trial [published online March 12, 2020]. Gastroenterology. doi:10.1053/j.gastro.2020.03.014