Post-resection Treatment of Large Colon Polyps

NCT ID: NCT03654209

Last Updated: 2024-01-05

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

384 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-10-16

Study Completion Date

2022-12-14

Brief Summary

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Patients who have provided informed consented and are scheduled to undergo endoscopic mucosal resection (EMR) of lesions 15mm and larger will be randomized to STSC (80 W, Effect 5) vs APC (preferred settings) vs No Treatment of the perimeter of the EMR site.

Detailed Description

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Data regarding polyp morphology, location \& shape will be recorded in addition to procedure and treatment length. Injection fluid use and clipping will also be recorded in addition to any procedural complications.

All randomized subjects will receive a 30-day post procedure follow-up phone call and be scheduled, as per the standard of care, to receive a standard follow-up colonoscopy procedure after the initial procedure. The investigators will measure the rate of recurrence by endoscopic visualization of the EMR site at the first follow-up using endoscopic magnification and electronic chromoendoscopy, as well as systematic biopsy of the scars.

Conditions

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Recurrence

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Patients will be randomized to Argon Plasma Coagulation vs Snare Tip Soft Coagulation vs no treatment
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Argon Plasma Coagulation

Following polyp removal using standard of care methods, Argon Plasma Coagulation (APC) will be applied to the perimeter of the resection site before any clips are added.

Group Type EXPERIMENTAL

Argon Plasma Coagulation

Intervention Type DEVICE

APC will be applied to the perimeter of the resection site

Snare Tip Soft Coagulation

Following polyp removal using standard of care methods, Snare Tip Soft Coagulation (STSC) will be applied to the perimeter of the resection site before any clips are added.

Group Type EXPERIMENTAL

Snare Tip Soft Coagulation

Intervention Type DEVICE

STSC will be applied to the perimeter of the resection site

No treatment

Following polyp removal using standard of care methods, neither APC nor STSC will be applied to the perimeter of the resection site. Clips may be added at the discretion of the PI.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Argon Plasma Coagulation

APC will be applied to the perimeter of the resection site

Intervention Type DEVICE

Snare Tip Soft Coagulation

STSC will be applied to the perimeter of the resection site

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* 25 years and older
* Ability to provide informed consent
* Undergoing colonoscopy for screening, surveillance, diagnostic reasons, or removal of a lesion

Exclusion Criteria

* Pedunculated lesions
* Inflammatory bowel disease
* Inability to provide informed consent
* Lesions less than 15mm in largest dimension
Minimum Eligible Age

25 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Erbe USA Incorporated

OTHER

Sponsor Role collaborator

Indiana University

OTHER

Sponsor Role lead

Responsible Party

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Douglas K. Rex

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Douglas K. Rex, MD

Role: PRINCIPAL_INVESTIGATOR

Indiana University

Locations

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Sibley Memorial Hospital

Washington D.C., District of Columbia, United States

Site Status

AdventHealth Orlando

Orlando, Florida, United States

Site Status

Indiana University Health University Hospital

Indianapolis, Indiana, United States

Site Status

Spring Mill Medical Center

Indianapolis, Indiana, United States

Site Status

The University of Kansas Medical Center

Kansas City, Kansas, United States

Site Status

The Johns Hopkins Hospital

Baltimore, Maryland, United States

Site Status

Dartmouth-Hitchcock Medical Center

Lebanon, New Hampshire, United States

Site Status

NYU Langone Medical Center

New York, New York, United States

Site Status

The Mount Sinai Hospital

New York, New York, United States

Site Status

Penn State Health Milton S. Hershey Medical Center

Hershey, Pennsylvania, United States

Site Status

Countries

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United States

References

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Zhan T, Hielscher T, Hahn F, Hauf C, Betge J, Ebert MP, Belle S. Risk Factors for Local Recurrence of Large, Flat Colorectal Polyps after Endoscopic Mucosal Resection. Digestion. 2016;93(4):311-7. doi: 10.1159/000446364. Epub 2016 Jun 7.

Reference Type BACKGROUND
PMID: 27271329 (View on PubMed)

Brooker JC, Saunders BP, Shah SG, Thapar CJ, Suzuki N, Williams CB. Treatment with argon plasma coagulation reduces recurrence after piecemeal resection of large sessile colonic polyps: a randomized trial and recommendations. Gastrointest Endosc. 2002 Mar;55(3):371-5. doi: 10.1067/mge.2002.121597.

Reference Type BACKGROUND
PMID: 11868011 (View on PubMed)

Tate DJ, Bahin FF, Desomer L, Sidhu M, Gupta V, Bourke MJ. Cold-forceps avulsion with adjuvant snare-tip soft coagulation (CAST) is an effective and safe strategy for the management of non-lifting large laterally spreading colonic lesions. Endoscopy. 2018 Jan;50(1):52-62. doi: 10.1055/s-0043-119215. Epub 2017 Oct 11.

Reference Type BACKGROUND
PMID: 29020690 (View on PubMed)

Rex DK, Haber GB, Khashab M, Rastogi A, Hasan MK, DiMaio CJ, Kumta NA, Nagula S, Gordon S, Al-Kawas F, Waye JD, Razjouyan H, Dye CE, Moyer MT, Shultz J, Lahr RE, Yuen PYS, Dixon R, Boyd L, Pohl H. Snare Tip Soft Coagulation vs Argon Plasma Coagulation vs No Margin Treatment After Large Nonpedunculated Colorectal Polyp Resection: a Randomized Trial. Clin Gastroenterol Hepatol. 2024 Mar;22(3):552-561.e4. doi: 10.1016/j.cgh.2023.09.041. Epub 2023 Oct 21.

Reference Type DERIVED
PMID: 37871841 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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1805411306

Identifier Type: -

Identifier Source: org_study_id

NCT04063280

Identifier Type: -

Identifier Source: nct_alias

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