Comparison of three electrosurgical modes for endoscopic mucosal resection of colorectal polyps 10-20mm in size: a randomized controlled study

Background and Aims: Endocut Q (effect 2, effect 3 and effect 4) was commonly used when endoscopic mucosal resection (EMR) removing colorectal polyps. However, there is debate over the type of electrosurgical setting of Endocut Q being recommended in clinical practice. We performed a randomized, controlled trial to assess the effectiveness and safety of three effects when EMR removing the non-pedunculated colorectal polyps 10mm-20mm in size. Methods: Patients with non-pedunculate colorectal polyps undergoing EMR were randomly allocated into the effect 2, effect 3 and effect 4 group. The primary outcomes were the rates of intra-procedural bleeding. The secondary outcomes were the rates of post-procedural bleeding, perforation, complete resection, en bloc resection, R0 resection and residual polyps. Results: A total of 2637 eligible patients were included in the study and randomly assigned into effect 2, effect 3, or effect 4 group. There were no significant differences among three groups in regards to their baseline characteristics (P>0.05). Additionally, no significant differences were observed in terms of the rates of post-procedural bleeding, perforation, complete resection, en bloc resection, R0 resection, residual polyps, and post-polypectomy syndrome (P>0.05). However, the rate of intra-procedural bleeding was significantly lower in the effect 2 group than in the effect 3 and effect 4 group (4.0% vs. 12.2% vs. 12.7%, P<0.01). Conclusion: Endocut Q (effect 2, effect 3 and effect 4) were effective and safe to remove non-pedunculated colorectal polyps 10-20mm in size. However, effect 2 may be superior to effect 3 and effect 4 in reducing intra-procedural bleeding.