Vol.:(0123456789) 1 3 Digestive Diseases and Sciences https://doi.org/10.1007/s10620-019-05666-8 ORIGINAL ARTICLE Prophylactic Snare Tip Soft Coagulation and Its Impact on Adenoma Recurrence After Colonic Endoscopic Mucosal Resection Pujan Kandel 1  · Monia E. Werlang 1  · Issac R. Ahn 1  · Timothy A. Woodward 1  · Massimo Raimondo 1  · Ernest P. Bouras 1  · Michael B. Wallace 1  · Victoria Gómez 1 Received: 8 March 2019 / Accepted: 7 May 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019 Abstract Background Up to 20% of patients can have recurrence of adenomatous tissue at frst surveillance study after colon endo- scopic mucosal resection of large polyps. Aims To determine whether an educational intervention discussing thermal ablation of lateral margins of the mucosectomy site of post-endoscopic mucosal resection defect with snare tip soft coagulation (STSC) would decrease adenoma recurrence. Methods We performed a single-center quality improvement project from November 1, 2016, to November 30, 2017. Gas- troenterologists underwent an educational intervention demonstrating the treatment of peripheral margins of mucosectomy site with STSC after standard mucosectomy technique. These cases (intervention group) were compared with consecutive procedures performed prior to commencement of the quality improvement study (pre-intervention group). Patients with large colorectal lesions (≥ 20 mm) were included. Results Of the 120 patients here included, overall demographics of the groups were similar and the most common histol- ogy was sessile serrated adenoma (study group 45% vs 32% control group). Adenoma recurrence on intervention group and pre-intervention group was 12% versus 30%; p = 0.01. On univariate analysis, biopsy prior to mucosectomy, intraprocedural bleeding, and application of STSC on mucosectomy defect were the strongest predictors of adenoma recurrence. Adenoma recurrence in the intervention group was signifcantly lower than in the pre-intervention group in both univariate (odds ratio, 0.3 [95% CI, 0.11–0.80]) and multivariate analyses (odds ratio, 0.2 [95% CI, 0.12–0.92]). Conclusions The implementation of STSC of post-endoscopic mucosal resection peripheral defects is clinically feasible and signifcantly decreased adenoma recurrence. Keywords Colorectal polyps · Endoscopic mucosal resection · Snare tip soft coagulation · Adenoma recurrence · Quality improvement Abbreviations EMR Endoscopic mucosal resection Nd:YAG Neodymium-doped yttrium aluminum garnet SC1 First surveillance colonoscopy STSC Snare tip soft coagulation Introduction Colonoscopy and polypectomy reduce the incidence of colorectal cancer by approximately 50% in long-term fol- low-up [1]. While removal of small polyps is a routine pro- cedure during endoscopy, resection of colorectal lesions larger than 20 mm is more complex and requires advanced endoscopic techniques such as endoscopic mucosal resec- tion (EMR) and endoscopic submucosal dissection (ESD). Pujan Kandel and Monia E. Werlang have contributed equally to this work. Mayo Clinic does not endorse specifc products or services included in this article. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10620-019-05666-8) contains supplementary material, which is available to authorized users. * Victoria Gómez Gomez.victoria@mayo.edu 1 Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA