title: A prospective comparative study of blended and pure coagulation current in endoscopic mucosal resection of large sessile colorectal polyps.
abstract: BACKGROUND
  The aim of this study was to compare pure coagulation and blended current in the resection of large colorectal sessile polyps (SPs).
  
  
  METHODS
  Between January 2009 and June 2012, 84 patients (45 men, 39 women; median age 66 y; range, 42 to 88 y) with large colorectal SPs (diameter ≥2 cm) were randomized in 1:1 ratio to undergo treatment by the "lift and cut" piecemeal resection technique. A total of 43 blended current subjects (group A) were well matched to 41 pure coagulation current subjects (group B), with a median lesion size of 3.9 cm (group A, 3.7 vs. group B, 4.2 cm; P=0.316), respectively. The rate of complications, the factors that predict complications, and the recurrence of adenoma were analyzed.
  
  
  RESULTS
  Complete macroscopic resection was achieved in 39 patients (90.7%) of group A and in 36 patients (87.6%) of group B (P=0.735). Argon plasma coagulation at resection's margins was performed in 10 patients (23.2%) of group A and in 14 patients (34.1%) of group B (P=0.269). Eight patients (9.5%) [group A, n=3 patients (7.1%) vs. group B, n=5 patients (12%); P=0.756] developed immediate (4) or delayed (4) bleeding. Four patients with bleeding were under treatment with selective serotonin reuptake inhibitors. All bleedings were successfully treated conservatively or with endoclipping and heater probe application. Perforation occurred in 1 patient of each group and was managed by clips closure and antibiotics and right hemicolectomy, respectively. Postpolypectomy syndrome was observed in 2 patients (4.6%) of group A and 3 patients (7.3%) of group B (P=0.834). In 3 patients, the histopathologic analysis of resected SPs revealed invasive carcinoma, and surgical resection was performed in 1 patient. Two patients refused operation. Among the patients who underwent follow-up surveillance colonoscopy, a total recurrence rate of 25.67% of adenomas with no difference was observed between the 2 groups [group A, n=8 patients (21.6%) vs. group B, n=11 patients (31.4%); P=0.345]. Recurrence of adenoma was observed in 12 patients (16.22%) without and in 7 patients (9.46%) with argon plasma coagulation treatment.
  
  
  CONCLUSIONS
  No difference was found in the rate of complications between the 2 types of current used in the resection of large colorectal SPs. However, an influence of selective serotonin reuptake inhibitors on postpolypectomy bleeding was observed, which deserves further investigation.
authors.affiliation: *Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital; School of Medicine ‡2nd Department of Internal Medicine, Hippokratio Hospital, Aristotle University of Thessaloniki, Thessaloniki †Department of Gastroenterology, University Hospital of Thessaly, Larissa, Greece.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Katsinelos
authors.forename: Stergios
authors.initials: S
authors.lastname: Gkagkalis
authors.forename: George
authors.initials: G
authors.lastname: Paroutoglou
authors.forename: Grigoris
authors.initials: G
authors.lastname: Chatzimavroudis
authors.forename: Kostas
authors.initials: K
authors.lastname: Fasoulas
authors.forename: Christos
authors.initials: C
authors.lastname: Zavos
authors.forename: Kostas
authors.initials: K
authors.lastname: Varitimiadis
authors.forename: Georgia
authors.initials: G
authors.lastname: Lazaraki
authors.forename: George
authors.initials: G
authors.lastname: Kotronis
authors.forename: Jannis
authors.initials: J
authors.lastname: Kountouras
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control; D017115:Catheter Ablation / Q000379:methods; D003111:Colonic Polyps / Q000175:diagnosis / Q000601:surgery; D003113:Colonoscopy / Q000379:methods; D005500:Follow-Up Studies; D016558:Hemostasis, Endoscopic / Q000379:methods; D007413:Intestinal Mucosa / Q000601:surgery; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D011446:Prospective Studies; D016896:Treatment Outcome