Cold Snare Endoscopic Mucosal Resection (C-EMR) Versus Hot Snare Endoscopic Mucosal Resection (H-EMR) for Large Colorectal Polyps (10-20 mm)

NCT ID: NCT06180798

Last Updated: 2024-01-30

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

330 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-01-10

Study Completion Date

2024-12-30

Brief Summary

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OBJECTIVES The aim of the study is to compare the efficacy of cold snare EMR versus hot snare EMR for non-pedunculated polyps 10-20mm in size with respect to complete resection rates and adverse events.

DESIGN : A Randomised interventional study. Sample size: 330

Detailed Description

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* This procedure will be performed by Endoscopists having above 3 years of experience you will be in the left lateral position under propofol sedation.
* In Both groups (a mixture of saline and blue dye will be injected beneath the surface layer,and then a snare(is a ring shaped device used to cut polyp after surrounding it- like a rubber band ) will be used to remove tissue without using heat in Cold Endoscopic mucosal resection group and using electrosurgical unit (to control bleeding and to rapidly dissect soft tissue in surgery) by EndoCut Q mode (ensures safe and effective removal of large lesions in particular large polyps) in Hot Endoscopic mucosal resection group.
* After polypectomy (the surgical removal of a polyp) the area is inspected for residual polyp (presence of any type of tissue) using NBI (Narrow band imaging) and if present, will be CUT OFF.

* A Standard snare ( snare is a ring shaped device used to cut polyp after surrounding it- like a rubber band) is used to cut the polyps

Conditions

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Polyps of Colon Polyps Polyp Intestine

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

This is a single center randomized controlled study with two parallel groups with a 1:1 allocation ratio.
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants
The patients will be randomised to C-EMR and H-EMR by a computer generated sequence provided in turn by the research assistant. The patient, pathologist and statistician will be blinded.

Study Groups

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cold snare endoscopic mucosal resection (C-EMR)

All procedures will be performed by experienced endoscopists (\>3 years of experience/\>1000 polypectomies) with the patient in the left lateral position under propofol sedation.submucosal injection of saline mixed with methylene blue will be used (no epinephrine) followed by resection using snare without using electrocautery in C-EMR group.The polyp size will be assessed by boston biopsy forceps (open jaws -7mm) or boston jumbo biopsy forceps (open jaws 10mm) or submucosal injection needle (Olympus (4mm)). A standard snare will be used.After polypectomy, the area is inspected for residual polyp using NBI and if present, will be resected using biopsy forceps.

Group Type ACTIVE_COMPARATOR

cold snare endoscopic mucosal resection (C-EMR)

Intervention Type PROCEDURE

All procedures will be performed by experienced endoscopists (\>3 years of experience/\>1000 polypectomies) with the patient in the left lateral position under propofol sedation.

The polyp size will be assessed by boston biopsy forceps (open jaws -7mm) or boston jumbo biopsy forceps (open jaws 10mm) or submucosal injection needle (Olympus (4mm)). A standard snare will be used .

submucosal injection of saline mixed with methylene blue will be used (no epinephrine) followed by resection using snare without using electrocautery in C-EMR group.After polypectomy, the area is inspected for residual polyp using NBI and if present, will be resected using biopsy forceps.

Bleeding will be assessed for 2 mins to decide upon requirement of immediate hemostatic methods in the form of clipping or electrocoagulation.

Hot snare endoscopic mucosal resection (H-EMR)

All procedures will be performed by experienced endoscopists (\>3 years of experience/\>1000 polypectomies) with the patient in the left lateral position under propofol sedation.Using ERBE electrosurgical unit - EndoCut Q mode (effect interval duration) and forced coagulation mode in H-EMR group.The polyp size will be assessed by boston biopsy forceps (open jaws -7mm) or boston jumbo biopsy forceps (open jaws 10mm) or submucosal injection needle (Olympus (4mm)). A standard snare will be used.After polypectomy, the area is inspected for residual polyp using NBI and if present, will be resected using biopsy forceps.

Group Type SHAM_COMPARATOR

Hot snare endoscopic mucosal resection (H-EMR)

Intervention Type PROCEDURE

All procedures will be performed by experienced endoscopists (\>3 years of experience/\>1000 polypectomies) with the patient in the left lateral position under propofol sedation.

The polyp size will be assessed by boston biopsy forceps (open jaws -7mm) or boston jumbo biopsy forceps (open jaws 10mm) or submucosal injection needle (Olympus (4mm)). A standard snare will be used.submucosal injection of saline mixed with methylene blue will be used.Using ERBE electrosurgical unit - EndoCut Q mode (effect interval duration) and forced coagulation mode in H-EMR group.

After polypectomy, the area is inspected for residual polyp using NBI and if present, will be resected using biopsy forceps.

Interventions

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cold snare endoscopic mucosal resection (C-EMR)

All procedures will be performed by experienced endoscopists (\>3 years of experience/\>1000 polypectomies) with the patient in the left lateral position under propofol sedation.

The polyp size will be assessed by boston biopsy forceps (open jaws -7mm) or boston jumbo biopsy forceps (open jaws 10mm) or submucosal injection needle (Olympus (4mm)). A standard snare will be used .

submucosal injection of saline mixed with methylene blue will be used (no epinephrine) followed by resection using snare without using electrocautery in C-EMR group.After polypectomy, the area is inspected for residual polyp using NBI and if present, will be resected using biopsy forceps.

Bleeding will be assessed for 2 mins to decide upon requirement of immediate hemostatic methods in the form of clipping or electrocoagulation.

Intervention Type PROCEDURE

Hot snare endoscopic mucosal resection (H-EMR)

All procedures will be performed by experienced endoscopists (\>3 years of experience/\>1000 polypectomies) with the patient in the left lateral position under propofol sedation.

The polyp size will be assessed by boston biopsy forceps (open jaws -7mm) or boston jumbo biopsy forceps (open jaws 10mm) or submucosal injection needle (Olympus (4mm)). A standard snare will be used.submucosal injection of saline mixed with methylene blue will be used.Using ERBE electrosurgical unit - EndoCut Q mode (effect interval duration) and forced coagulation mode in H-EMR group.

After polypectomy, the area is inspected for residual polyp using NBI and if present, will be resected using biopsy forceps.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Adult above 18 years
* polyp size greater than 5-10mm.

Exclusion Criteria

* Inflammatory bowel disease
* Familial Polyposis Syndromes
* Patient who is unable to understand study protocol or not consenting
* Severe coagulopathy (INR Greater than 1.5 platelets)
* Receiving antiplatelets withing 5 days of procedure
* If antiplatelets stopped for 5 days-they were restarted on next day after procedure.
Minimum Eligible Age

18 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Asian Institute of Gastroenterology, India

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Krithi Krishna Koduri, MD

Role: PRINCIPAL_INVESTIGATOR

Asian Institute of Gastroenterology

Locations

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Krithi Krishna Koduri

Hyderabad, Telanagana, India

Site Status RECRUITING

Countries

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India

Central Contacts

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Krithi Krishna Koduri, MD

Role: CONTACT

9870083545 ext. 91

Nitin Jagtap, MD

Role: CONTACT

9182859523 ext. 91

Facility Contacts

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Nitin Jagtap, MD

Role: primary

Other Identifiers

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C-EMR VS H-EMR

Identifier Type: -

Identifier Source: org_study_id

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