Comparing Precutting Endoscopic Mucosal Resection Using Snare-Tip and Endoscopic Submucosal Dissection Knife for Large Nonpedunculated Colorectal Polyps: A Randomized Controlled Trial

INTRODUCTION: Precutting endoscopic mucosal resection (EMR-P) is a modified EMR method for the resection of large nonpedunculated colorectal polyps. In EMR-P, a mucosal incision is made using a snare-tip or endoscopic submucosal dissection (ESD) knife. However, there are concerns that the snare-tip may have a lower procedural success rate than the ESD knife. We aimed to assess the efficacy and safety of EMR-P using a snare-tip compared with that using an ESD knife for large nonpedunculated colorectal polyps. METHODS: Large nonpedunculated colorectal polyps (15-25 mm) were randomly allocated to either the snare-tip or ESD knife EMR-P group. The primary outcome was the en bloc resection rate. RESULTS: Resection was performed using a snare-tip or ESD knife in 53 patients each. In the intention-to-treat population, the en bloc resection rates for the snare-tip and ESD knife EMR-P groups were not significantly different (98.1% vs 98.1%, P = 1.000). The R0 resection rate in the snare-tip group was not significantly different from that in the ESD knife group (88.7% vs 92.5%, P = 0.663). The total procedure time was 8.9 minutes (interquartile range 7.5-10.3) and 9.3 minutes (interquartile range 7.2-10.9) in the snare-tip and ESD knife groups, respectively ( P = 0.550). The local recurrence rate was 0% in both groups. No perforations were observed in either group. DISCUSSION: EMR-P using a snare-tip was noninferior to EMR-P using a ESD knife for large nonpedunculated colorectal polyps. EMR-P using a snare-tip is considered as effective and safe as an ESD knife.