We congratulate Djinbachian et al on their recent publication that addressed the utility of hybrid argon plasma coagulation (hAPC) to mitigate recurrence after endoscopic mucosal resection (EMR) of large non-pedunculated colorectal polyps (LNPCPs).1 In a 3-centre study, involving 391 patients (427 LNPCPs), they reported a lower residual or recurrent adenoma rate (RRA of 0.9%) with combined margin and base ablation, when compared with margin ablation alone (8.8%) or no ablation (23.4%). The insights presented in this paper open discussion on the potential enhancement of EMR outcomes. Our extensive 15-year research experience at Westmead Hospital, Sydney, aligns closely with this topic. The authors’ rationale behind base ablation is the need to treat polyp areas that might evade capture during a piecemeal resection. However, a systematic approach to LNPCP EMR may preclude its occurrence. This involves a systematic resection, starting from the lesion’s edge, ensuring a wide margin and proceeding in a one-way direction. Once the submucosal plane is entered, it is important that subsequent snare placement …

中文翻译：

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内镜下粘膜切除术治疗大型无蒂结直肠息肉：采用安全、有效且具有成本效益的技术保持正轨


我们祝贺 Djinbachian 等人最近发表的论文，该论文探讨了混合氩等离子体凝固 (hAPC) 的实用性，以减轻大型无蒂结直肠息肉 (LNPCP) 内镜粘膜切除 (EMR) 后的复发。1 在一项 3 中心研究中，涉及 391 名患者（427 名 LNPCP），他们报告说，与单独边缘消融（8.8%）或不消融（23.4%）相比，联合边缘和基底消融的残留或复发腺瘤率（RRA 为 0.9%）较低。本文提出的见解引发了关于 EMR 结果潜在增强的讨论。我们在悉尼 Westmead 医院 15 年的丰富研究经验与这一主题密切相关。作者的基础消融背后的基本原理是需要治疗在分段切除过程中可能逃避捕获的息肉区域。然而，LNPCP EMR 的系统方法可能会阻止其发生。这涉及系统性切除，从病变边缘开始，确保较宽的边缘并沿单向方向进行。一旦进入粘膜下平面，随后的圈套器放置就很重要......