Hot- Versus Cold-Snare Endoscopic Mucosal Resection for Non-Ampullary Duodenal Lesions: Consolidating the Cold Revolution into Clinical Practice - European Medical Journal

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Hot- Versus Cold-Snare Endoscopic Mucosal Resection for Non-Ampullary Duodenal Lesions: Consolidating the Cold Revolution into Clinical Practice

1 Mins
Gastroenterology
Authors:
*Andrawus Beany,1,2,3 Enrik John Torres Aguila,1,4 Anna Agnieszka Wawer,1,5 Dauda Bawa,1 Jin Tan,1,5 Rajvinder Singh1,5
  • 1. Department of Gastroenterology, Lyell McEwin Hospital, Elizabeth Vale, Australia
  • 2. Gastroenterology Institute, Rambam Health Care Campus, Haifa, Israel
  • 3. The Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
  • 4. St. Luke's Medical Center Global City, Institute of Digestive and Liver Diseases, Taguig City, Philippines
  • 5. University of Adelaide School of Medical Sciences, Adelaide, Australia
*Correspondence to [email protected]
Disclosure:

The authors have declared no conflicts of interest.

Citation:
EMJ Gastroenterol. ;13[1]:28-29. https://doi.org/10.33590/emjgastroenterol/QJVH3160.
Keywords:
Cold snare endoscopic mucosal resection; hot-snare endoscopic mucosal resection; non-ampullary duodenal lesions

Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.

BACKGROUND AND AIMS

Endoscopic mucosal resection (EMR) has increasingly gained acceptance as a minimally invasive intervention for the treatment of duodenal lesions.1 Despite the overall good results, there can be significant morbidity associated with performing EMR in the duodenum. Data comparing hot- and cold-snare approaches in the duodenum are currently scarce.2,3,4 The authors’ aim was to assess the efficacy and safety of hot-snare EMR (H-EMR) versus cold-snare EMR (C-EMR) for the resection of non-ampullary duodenal lesions.

METHODS

A prospectively collected database of duodenal lesions treated using EMR at a single tertiary medical centre between 2010–2023 was performed. Patient demographics, lesion and procedure characteristics, outcomes, and adverse events were analysed using R statistical software. The lesion size and procedural time were analysed using the Mann-Whitney U test, while clinical outcomes were analysed using the Fisher’s exact test. Cost savings were calculated from the averted use of clips.

RESULTS

Seventy-one cases of non-ampullary duodenal lesions resected using the EMR technique were included (46 H-EMR; 25 C-EMR). Fifty-one lesions were resected en-bloc (31 H-EMR versus 20 C-EMR), while 20 lesions were resected in a piecemeal fashion (15 H-EMR versus 5 C-EMR). Similar demographics, lesion, and procedure characteristics were observed in both cohorts (Table 1). Technical success was 100%, and no delayed perforations occurred in either cohort. Lesions resected via H-EMR had higher rates of immediate perforation (2.2% versus 0%; p=1.0) and delayed bleeding (9.1% versus 0%; p=0.28) compared to C-EMR. Interestingly, recurrence rates were higher in the H-EMR arm (15.2% versus 8%; p=0.70). C-EMR technique achieved a crude cost saving from clips alone of 135 USD per patient compared to the H-EMR technique.

Table 1: Patient, lesion and procedure characteristics, and clinical outcomes.
APC: argon plasma coagulation; ASA: American Society of Anesthesiologists; CAST: Cold-forceps avulsion with adjuvant snare-tip soft coagulation; EMR: endoscopic mucosal resection; STSC: snare-tip soft coagulation.

CONCLUSION

While both cohorts demonstrated excellent technical success, there was a trend towards lower adverse events and recurrence rates, as well as cost savings, when C-EMR technique was used for non-ampullary duodenal lesions. The authors’ data consolidates previous findings and suggests an acceptable role of the cold resection approach in the duodenum. However, larger prospective comparative trials are warranted to bolster the present evidence and shape the state of the art.

References
Klein A et al. Endoscopic resection of large duodenal and papillary lateral spreading lesions is clinically and economically advantageous compared with surgery. Endoscopy. 2017;49:659-67. Trivedi M et al. Comparison of cold snare and hot snare polypectomy for the resection of sporadic nonampullary duodenal adenomas. Gastrointest Endosc. 2022;96:657-64.e2. Repici A et al. Cold versus hot EMR for large duodenal adenomas. Gut. 2022;71:1763-5. Wang H et al. Cold snare EMR for the removal of large duodenal adenomas. Gastrointest Endosc. 2023;97:1100-8.

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