Almost all polyps that pediatric gastroenterologist manage are pedunculated polyps.  Nevertheless, a recent study (H Pohl et al. Gastroenterol 2020; 159: 119-28. Full text: Effects of Blended (Yellow) vs Forced Coagulation (Blue) Currents on Adverse Events, Complete Resection, or Polyp Recurrence After Polypectomy in a Large Randomized Trial) on cautery for non-pedunculated polyps was intriguing.

Methods: This multicenter, randomized, controlled, single-blinded study enrolled patients with a large colorectal polyp across 18 medical centers between April 2013 and October 2017. N=928.  ERBE device.

Key finding:

• Equivalent results were noted with both blended current (Yellow) or forced coagulation (Blue)
  • “Serious adverse events occurred in 7.2% of patients in the Endocut (blended) group and 7.9% of patients in the forced coagulation group, with no significant differences in the occurrence of types of events.”
  • Proportions of polyps that were completely removed: 96% in the Endocut group vs 95% in the forced coagulation group
  • Proportion of polyps found to have recurred at surveillance colonoscopy: 17% for both groups
  • “Endocut more frequently caused intraprocedural bleeding that required treatment than forced coagulation (17% vs 11%). In contrast, small residual tissue islands were more frequently described in the forced coagulation group than in the Endocut group.”

Discussion: 

• “We also did not include pedunculated polyps. Because these polyps have a greater risk of immediate bleeding, we may infer from our study that it may be safer to apply a coagulation current with a lower risk of immediate bleeding to these polyps.”

My take: Both of these settings yielded similar results.  For now, with pedunculated polyps, probably best to rely on the coagulation setting (Blue).

Related blog posts:

• How to Do a Colonscopic Polypectomy
• How Benign Are Juvenile Polyps?
• Adverse Events Following Pediatric Endoscopy -Previously Underestimated
• ESPGHAN Juvenile Polyposis Position Paper
• While the polyps described are not tubular adenomatous polyps, it is noted that guidelines in adults recommend followup in 5-10 years for a single (non-serrated) adenomatous polyp (Polyps: Clinical Decision Tool).
• Updated Guidelines on Genetic Testing/management for Hereditary GI Cancer Syndromes
• Surprising Genetic Mutations in Polyposis Study
• Polyposis in Pediatric Patients -Review
• Consensus guidelines after polypectomy | gutsandgrowth)
• Adenoma Detection Rate: Life or Death Quality Measure

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