Hybrid Resection versus Conventional Resection for Laterally Spreading Lesions of the Papilla

Conventional hot-snare resection (CR) of laterally spreading papillary adenomas (LSL-P) is effective, however can be associated with delayed bleeding (DB) in upwards of 25% of cases. Given the excellent safety-profile of the cold-snare polypectomy in the colorectum, we investigated the efficacy and safety of a novel hybrid hot-snare plus cold-snare resection (HR) technique for LSL-P management.A prospective cohort of patients underwent HR in a tertiary referral center over 60 months until December 2022. This was compared to a historical cohort of patients that underwent CR at the same institution over 120 months until August 2017. The primary outcomes were recurrence and bleeding.20 patients underwent HR (14 female, mean age 65.2±12.2 years). Median lesion size was 30 mm (IQR 25.0-47.5mm). Recurrent or residual adenoma (RRA) was greater with HR (n=10, 58.8% vs. n=14, 29.8%, P=0.034). The odds ratio for recurrence was 3.6 times (95%CI 1.2-11.0) higher with HR (P=0.027). RRA was multi-focal in 4 (40%) and had a composite RRA volume of >10 mm in 7 (70%). The median number of procedures required to treat RRA was higher with HR (4 vs. 1, P=0.002). There was no difference between CR and HR for intraprocedural bleeding (n=23, 41.1% vs. n=5, 25%, P=0.587) or DB (25.0% vs. 10.0%, P=0.211). There were no perforations.The novel hybrid resection technique for LSL-P management is associated with a high rate of RRA that is recalcitrant to treatment, without mitigating the risk of intraprocedural or delayed bleeding. Therefore, conventional hot-snare resection should remain the mainstay management option for treating patients with an LSL-P.