Efficacy and Safety of Precut-EMR for Resecting of Colonic Polyp

Study Overview
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Brief Summary
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This study was attempted to determine the efficacy and complication of precut EMR comparing with convetional EMR for resecting of 10   20 mm colon polyp through prospective, randomized controlled trial.

Detailed Description
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In general, a potential risk of advanced colorectal neoplasia is proportional with size. However, recent study report that occurence rate of advanced neoplasia in small polyp is 9   10 %. And, incidence of interval cancer after screening colonoscopy was reported as 10   27%. So We can suspect that complete resection of small polyp is important. Previous study recommended that endoscopic submucosal dissection (ESD) is a safe and effective procedure for treating colon polyp larger than 20 mm because of high complete resection rate and low recurrence rate. In contrast, endoscopic mucosal resection (EMR) is more recommended for resecting colon polyp smaller than 20 mm because of technical ease and low rate of complication. However, Complete resection rate of conventional EMR is 60   70%. In case of incomplete resection, local recurrence rate is higher than complete resection. And In case of adenocarcinoma, specimen of piecemeal resection cannot be evaluated a depth of invasion and resection margin, and physician cannot decide a therapeutic plan. In precut-EMR, mucosal resection is performed after pre-incision around a polyp. When precut EMR of polyp > 20 mm was performed in previous study, complete resection rate and en-bloc resection rate were higher and local recurrence rate was lower than conventional EMR. But, there is no study of comparsion precut EMR and conventional EMR for resecting colon polyp < 20 mm. This study was attempted to determine the efficacy and complication of precut EMR comparing with convetional EMR through prospective, randomized controlled trial.

Official Title
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Comparison Between EMR and Precut-EMR for Colorectal Polyp; Randomized Prospective Study

Conditions
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Colonic Polyps

Intervention / Treatment
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* Procedure: Precut EMR
* Procedure: Conventional MER


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All patients older than 20 years old who had 10 20 mm colon polyp and agreed to participate a research Exclusion Criteria: Medication history of antiplatelet agent within a week of procedure. Medical history of coagulopathy More than American Society of Anesthesiology class III Medical history of liver cirrhosis, chronic kidney disease, malignancy, inflammatory bowel disease, severe inflammatory disease. pedunculated polyp and polyp with malignant potential.

Ages Eligible for Study
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Minimum Age: 20 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Precut-EMR<br>For treating of 10 20mm colon polyp, patient will be randomly divided into two groups, a Precut-EMR group and a EMR group. In Precut-EMR, endoscopist submucosally inject with saline around a polyp. Subsequently, circumferential incision/precutting was made with the tip of the snare around 2 mm outside the tumor. After that, the snare was positioned in the cut groove and tightend, and the tumor was resected using electrical current. | Procedure: Precut EMR<br>* For treating of 10 20mm colon polyp, patient will be randomly divided into two groups, a Precut-EMR group and a EMR group. In Precut-EMR, endoscopist submucosally inject with saline around a polyp. Subsequently, circumferential incision/precutting was made with the tip of the snare around 2 mm outside the tumor. After that, the snare was positioned in the cut groove and tightend, and the tumor was resected using electrical current.<br>|
| Active Comparator: Conventional EMR<br>For treating of 10 20mm colon polyp, patient will be randomly divided into two groups, a Precut-EMR group and a EMR group. Conventional EMR had been widely used technique. Endoscopist submucosally inject with saline around a polyp. After that, snare is positioned around a polyp, and polyp was resected using electrical current | Procedure: Conventional MER<br>* EMR had been widely used technique. Endoscopist submucosally inject with saline around a polyp. After that, snare is positioned around a polyp, and polyp was resected using electrical current.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Histologic complete resection rate |  | baseline ( enrollment of all planned patient) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Procedure time |  | procedure | 
| Complication such as perforation, bleeding |  | baseline ( enrollment of all planned patient) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Colonic polyps, Colonoscopy