Margin marking before colorectal endoscopic mucosal resection and its impact on neoplasia recurrence (with video).

BACKGROUND AND AIMS: Ablation of resection margins after EMR of large nonpedunculated colorectal polyps decreases recurrence. Margin marking before EMR (EMR-MM) may represent an alternative method to achieve a healthy resection margin. We aimed to determine the efficacy of EMR-MM in reducing neoplasia recurrence. METHODS: We conducted a single-center historical control study of EMR cases (EMR-MM vs conventional EMR) for nonpedunculated polyps ≥20 mm between 2016 and 2021. For EMR-MM, cautery marks were placed along the lateral margins of the polyp with the snare tip. EMR was then performed to include resection of the healthy mucosa containing the marks. We compared recurrence at surveillance colonoscopy after EMR-MM versus historical control subjects. Multivariable logistic regression was performed to identify factors associated with recurrence. RESULTS: Two hundred ten patients with 210 polyps (median size, 30 mm; interquartile range: 25-40) underwent EMR-MM (n = 74) or conventional EMR (n = 136). Patient and lesion characteristics were similar between the groups. At a median follow-up of 6 months, the recurrence rate was lower with EMR-MM (6/74; 8%) compared with historical control subjects (39/136; 29%) (P < .001). EMR-MM was not associated with an increased rate of adverse events. On multivariable analysis, EMR-MM remained the strongest predictor of recurrence (odds ratio, .20; 95% confidence interval, .13-.64; P = .003) aside from polyp size (odds ratio, 2.81; 95% confidence interval, 1.35-6.01; P = .008). CONCLUSIONS: In this single-center historical control study, EMR-MM of large nonpedunculated colorectal polyps reduced the recurrence risk by 80% when compared with conventional EMR. This simple technique may provide an alternative to margin ablation.

Safety of cold resection of non-ampullary duodenal polyps: Systematic review and meta-analysis.

Background and study aims Endoscopic resection has traditionally involved electrosurgical cautery (hot snare) to resect premalignant polyps. Recent data have suggested superior safety of cold resection. We aimed to assess the safety of cold compared with traditional (hot) resection for non-ampullary duodenal polyps. Methods We performed a systematic review ending in September 2022. The primary outcome of interest was the adverse event (AE) rate for cold compared with hot polyp resection. We reported odds ratios with 95% confidence intervals (CIs). Secondary outcomes included rates of polyp recurrence and post-polypectomy syndrome. We assessed publication bias with the classic fail-safe test and used forest plots to report pooled effect estimates. We assessed heterogeneity using I 2 index. Results Our systematic review identified 1,215 unique citations. Eight of these met inclusion criteria, seven of which were published manuscripts and one of which was a recent meeting abstract. On random effect modeling, cold resection was associated with significantly lower odds of delayed bleeding compared with hot resection. The difference in the odds of perforation (odds ratio [OR] 0.31 [95% confidence interval [CI] 0.05-2.87], P =0.2, I 2 =0) and polyp recurrence (OR 0.75 [95% CI 0.15-3.73], P =0.72, I 2 =0) between hot and cold resection was not statistically significant. There were no cases of post-polypectomy syndrome reported with either hot or cold techniques. Conclusions Cold resection is associated with lower odds of delayed bleeding compared with hot resection for duodenal tumors. There was a trend toward higher odds of perforation and recurrence following hot resection, but this trend was not statistically significant.

Barrett's Esophagus in Obese Patient Post-Roux-en-Y Gastric Bypass: a Systematic Review.

PURPOSE: Barrett's esophagus (BE) is a relative contraindication for sleeve gastrectomy, but not for Roux-en-Y gastric bypass (RNY). However, studies assessing the effect of RNY on BE are limited. We aimed to conduct a systematic review and meta-analysis of studies of obese patients who also had BE and underwent RNY. MATERIALS AND METHODS: We conducted a systematic review of literature using multiple search engines from inception to January 2021. The primary outcome of interest was the rate of BE resolution post-RNY. This was reported as a proportion with 95% confidence intervals (CI). Publication bias was assessed by funnels plots and the classic fail test. Forest plots were used to report pooled effect estimates. Heterogeneity was assessed using I2 and p-value. RESULTS: The final search included 4389 citations, 16 were reviewed in full text, and 9 were included in the final analysis, including 7 manuscripts and 2 recent meeting abstracts. In the 9 studies, 104 patients had BE and underwent RNY. On random effect modeling, the rate of complete remission of intestinal metaplasia (CRIM) was 50% [95%CI: 40-61%], p = 0.937, I2 = 4.6%, Q = 8.4, p = 0.396. The pooled rate of BE improvement was 52% [95%CI: 37-66%], p = 0.8, I2 = 16.5%, Q = 4.8, p = 0.31. Complete remission of dysplasia (CRD) was also reported in 4 of 6 patients. CONCLUSION: Despite the limited data, a majority of patient with BE who underwent RNY for weight loss had remission or improvement in BE on follow-up endoscopy. However, a significant minority had no change to BE on follow-up.