Colorectal Neoplasms Clinical Trial
Official title:
Cold EMR Vs Standard EMR for the Treatment of Large Nonpedunculated Homogeneous Colorectal Lesions.Randomized and Multicentric Clinical Trial
Verified date | September 2023 |
Source | Hospital General Universitario Gregorio Marañon |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
This study compares the effectiveness in complete resection (absence of recurrence at 6 months) the two different techniques for performing endoscopic mucosal resection (EMR) of nonpedunculated homogeneous colorectal lesions >20mm
Status | Completed |
Enrollment | 229 |
Est. completion date | March 31, 2023 |
Est. primary completion date | December 31, 2022 |
Accepts healthy volunteers | Accepts Healthy Volunteers |
Gender | All |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria: - Patients of age > 18 years undergoing a colonoscopy for any reason of request and who do not meet exclusion criteria. - Nonpedunculated homogeneous colorectal lesions type LST ( Paris 0-IIa morphology) and serrated lesions larger than 20 mm without endoscopic data of malignancy: NICE 1 pattern +/- NICE 2 component ( serrated lesions) or NICE2 pattern/JNET 2A (adenomas) and therefore subsidiaries of RME. Randomization will be performed per patient, not for colorectal lesions - Signature of informed consent of endoscopic exploration Exclusion Criteria: - .No signature of informed consent prior to the study procedure. - Absence of proper suspension of the anticoagulant/antiplatelet therapy prior to procedure according to usual pre-procedure recommendations (BSG and ESGE guidelines) - Patients with severe thrombopenia/ coagulopathy (Platelets < 50,000/INR > 1.5) not corrected prior to procedure (plasma or platelet transfusion) - Patients not candidates for endoscopic resection of colorectal lesions by comorbidities. - Pregnant. - Patients with inflammatory bowel disease (IBD) - Urgent colonoscopy. - Poor preparation (BBPS <2 in the colon segment where the lesion is located) - Laterally spreading tumors (LST) lesions with non-homogeneous morphology including: sessile polyps (0-Is), pedunculated (0-Ip) and LST lesions with depressed or excavated components (Paris 0-IIc or Paris 0-III), LST granular nodular mixed, LST-G with whole nodular type. In case of doubt depressed component (Paris 0-IIc) or histological borderline lesion (JNET2B), will be excluded from the study. - Histological prediction of deep invasive or non-subsidiary to endoscopic mucosal resection lesion as a treatment of choice: NICE 3 pattern by inspection with NBI or Kudo V pattern in traditional/electronic chromoendoscopy or Sano IIIA/IIIB pattern - Endoscopic resection of post-EMR scar level relapses |
Country | Name | City | State |
---|---|---|---|
Spain | Óscar Nogales Rincón | Madrid |
Lead Sponsor | Collaborator |
---|---|
Oscar Nogales | Spanish Society of Digestive Endoscopy |
Spain,
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* Note: There are 15 references in all — Click here to view all references
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Complete resection of the lesion | Complete resection of the lesion is defined as the non-visualization by the endoscopist of a residual lesion in the mucosal defect and its edge at the end of the EMR and no visualization of recurrence in the post-EMR scar on the first surveillance colonoscopy and absence of recurrence data in scar biopsies | 3-6 months | |
Secondary | Security profile | Security profile is defined as the observed percentage of complications (Intra-procedure bleeding, deferred bleeding, deferred bleeding in antiplatelet and/or anticoagulated patients,post-polypectomy fever, post-polypectomy syndrome, deep muscle damage and perforation) in each of the evaluated techniques. | 30 days | |
Secondary | Late adenoma recurrence rate | Late adenoma recurrence rate as determined by endoscopic assessment (no visible recurrent adenoma) and histological assessment (scar biopsies) in surveillance colonoscopy at 18 months of the procedure | 18 months | |
Secondary | Number of fragments needed to complete the resection | Number of fragments needed to resect with polypectomy snare to complete the resection of the colorectal lesion. | 1 day | |
Secondary | Resection time | Time needed to perform endoscopic mucosal resection measured from first snare positioning until complete resection is achieved based on endoscopic assessment. | 1 day | |
Secondary | Bloc resection rate | Number of lesions that have undergone resection in a single fragment with each of these evaluated techniques. | 1 | |
Secondary | R0 resection rate | Number of lesions with complete macroscopic resection with a negative microscopic margin in the mucosectomy specimen | 1 day | |
Secondary | EMR technique conversion rate | Number of lesions to be finally resected with the other arm of study technique not initially assigned | 1 day | |
Secondary | Need for additional treatments to complete the resection. | Number of lesions that cannot be completely resected with the assigned EMR technique, requiring different techniques to complete the resection, such as SOFT coagulation with snare tip, APC (argon plasma coagulation), hot avulsion with hot biopsy forceps, biopsy forceps, biopsy forceps +ablation | 1 day | |
Secondary | Number of clips used | Number of clip used for hemostatic purposes or for the prophylactic closure of the injury | 1 day | |
Secondary | Degree of artifact/interference in the histological interpretation | Subjective impression of the artifact in the histological interpretation of the resected sample (null, moderate, severe) | 1 day | |
Secondary | Depth of the resected submucosa | Measure the depth of the resected submucosa layer (in microns) with each of the resection techniques used | 1 day | |
Secondary | Percentage of mucosal muscle present in the mucosal protrusions in the resection defect of cold-EMR. | Assess the percentage of presence of mucosal muscle in biopsies performed on the protrusions present in the resection defect of cold-EMR | 1 day | |
Secondary | Need for surgery for technical failure | Number of lesions that have to be finally resected by surgery due to technical impossibility for their endoscopic resection. | 6 months | |
Secondary | Cost-effectiveness study. | evaluate the cost-effectiveness of each of the endoscopic mucosal resection techniques | 18 months | |
Secondary | Sub-analysis by center participating in the study | A subanalysis of the study results by center will be carried out to rule out significant differences between them | 18 months |
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