Grant: Project Grant

Colorectal cancer (CRC) can be prevented by removing precancerous growths called polyps, which can develop into cancer if left untreated. Large polyps are usually removed using a technique called endoscopic mucosal resection (EMR), where the polyp is removed in multiple pieces. However, EMR can lead to complications, with the most common being delayed bleeding, occurring in up to 10% of patients. This can cause significant health issues and require additional medical care, such as emergency room visits and further medical procedures. Another potential complication is perforation, where the colon wall is injured, although this is less common. To reduce the risk of complications after EMR, endoscopists have tried closing the wound left by the removed polyp with endoscopic clips. While this approach has shown some promise in reducing complications, it is not always successful, partly due to limitations of older clip devices, which often fail to completely close the wound. Newer and more advanced endoscopic tools have been developed that are more effective at closing these wounds. Studies show that these new devices can achieve nearly complete closure in most cases, significantly reducing the risk of bleeding and other complications after EMR. These advancements suggest that ensuring complete closure of the wound after polyp removal may greatly improve patient outcomes and reduce the need for additional treatments. In this randomized controlled trial we will randomize patients to undergo either no closure of the resection wound or complete closure using these new closure devices. We will evaluate the chance of having a complication after EMR within 14 days when performing these two strategies.