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Recurrences of advanced sessile and lateral spreading colorectal adenoma after endoscopic mucosal resection (EMR) thermal ablation versus no adjuvant therapy (RESPECT): a protocol of an international randomized controlled trial

a protocol of an international randomized controlled trial
Authors: Gijs Kemper; Christian Gerges; Erik J. Schoon; Ramon-Michel Schreuder; Ruud R. W. Schrauwen; Ludger S. M. Epping; Torsten Beyna; +5 Authors

Recurrences of advanced sessile and lateral spreading colorectal adenoma after endoscopic mucosal resection (EMR) thermal ablation versus no adjuvant therapy (RESPECT): a protocol of an international randomized controlled trial

Abstract

Abstract Background Nowadays, large benign lateral spreading lesions (LSLs) and sessile polyps in the colorectum are mostly resected by endoscopic mucosal resection (EMR). A major drawback of EMR is the polyp recurrence rate of up to 20%. Snare tip soft coagulation (STSC) is considered an effective technique to reduce recurrence rates. However, clinical trials on STSC have mainly been conducted in expert referral centers. In these studies, polyp recurrence was assessed optically, and additional adjunctive techniques were excluded. In the current trial, we will evaluate the efficacy and safety of STSC in daily practice, by allowing adjunctive techniques during EMR and the use of both optical and histological polyp recurrence to assess recurrences during follow-up. Methods The RESPECT study is a multicenter, parallel-group, international single blinded randomized controlled superiority trial performed in the Netherlands and Germany. A total of 306 patients undergoing piecemeal EMR for LSLs or sessile colorectal polyps sized 20–60 mm will be randomized during the procedure after endoscopic complete polyp resection to the intervention or control group. Post-EMR defects allocated to the intervention group will be treated with thermal ablation with STSC of the entire resection margin. Primary outcome will be polyp recurrence by optical and histological confirmation at the first surveillance colonoscopy after 6 months. Secondary outcomes include technical success and complication rates. Discussion The RESPECT study will evaluate if STSC is effective in reducing recurrence rates after piecemeal EMR of large colorectal lesions in daily clinical practice performed by expert and non-expert endoscopists. Moreover, endoscopists will be allowed to use adjunctive techniques to remove remaining adenomatous tissue during the procedure. Finally, adenomatous polyp recurrence during follow-up will be defined by histologic identification. Trial registration ClinicalTrials.gov NCT05121805. Registered on 16 November 2021. Start recruitment: 17 March 2022. Planned completion of recruitment: 31 April 2025.

Keywords

Adenoma, Medicine (General), Endoscopic Mucosal Resection, Local neoplasm recurrence ; Colonoscopy/methods [MeSH] ; Neoplasm Recurrence, Local/prevention ; Randomized controlled trial ; Study Protocol ; Humans [MeSH] ; Thermal ablation ; Endoscopic Mucosal Resection/adverse effects [MeSH] ; Treatment Outcome [MeSH] ; Colorectal Neoplasms/surgery [MeSH] ; Endoscopic mucosal resection ; Adenoma/surgery [MeSH] ; Multicenter Studies as Topic [MeSH] ; Randomized Controlled Trials as Topic [MeSH] ; Colonic polyps ; Colonic Polyps/surgery [MeSH] ; Colorectal Neoplasms/pathology [MeSH] ; Adenoma/pathology [MeSH] ; Colonoscopy/adverse effects [MeSH], Local neoplasm recurrence, Colonic Polyps, Colonoscopy, Colonic polyps, Thermal ablation, Study Protocol, R5-920, Treatment Outcome, Randomized controlled trial, Endoscopic mucosal resection, Humans, Multicenter Studies as Topic, Gastroenterology - Radboud University Medical Center, Neoplasm Recurrence, Local, Colorectal Neoplasms, Randomized Controlled Trials as Topic

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
2
Average
Average
Average
Green
gold