Reducing Neoplasia Recurrence After Endoscopic Resection of Large Colorectal Polyps

Large (≥20mm) colorectal polyps often harbor areas of advanced neoplasia, making them immediate colorectal cancer (CRC) precursors. Such polyps have to be completely removed to prevent CRC and to avoid surgery and/or adjuvant therapy. The laterally spreading lesions (LSLs) are removed via endoscopic mucosal resection (EMR). However, recurrence is common. New techniques for LSL resection (hybrid argon plasma coagulation (h-APC) margin and base ablation) have shown a reduction in recurrence following the interventions. We hypothesize that performing hybrid argon plasma coagulation (h-APC) margin and base ablation during EMR of large (≥20mm) colorectal LSLs will lead to lower rates of lesion recurrence compared to Snare tip soft coagulation (STSC) margin ablation.

Inclusion Criteria: * adult ≥18 years old * patients undergoing EMR for a large (≥20mm) colorectal LSL * patients providing written and informed consent for study participation. Exclusion Criteria: * inflammatory bowel disease; * non-elective colonoscopy; * poor general health (American Society of Anesthesiologists classification \>III); * coagulopathy or thrombocytopenia (international normalized ratio ≥1.5 or platelets \