The ABLATION Trial: Evaluating New Techniques for Safer, More Effective Removal

Colorectal cancer often begins as a small polyp in the colon that slowly grows until it becomes cancerous. Research shows that once a polyp reaches about 20mm in size, it can quickly progress to cancer. Removing these larger polyps early is key to preventing cancer and avoiding major treatments like surgery or chemotherapy.

During a colonoscopy, physicians use an advanced procedure called Endoscopic Mucosal Resection (EMR) to remove large polyps. In this procedure, the doctor injects fluid to lift the polyp from the colon wall and then removes it piece by piece using a snare. Although EMR is effective, about 20% of patients experience recurrence of polyps, which may require further colonoscopies, additional EMR procedures, or even surgery.

To reduce recurrence, one method—snare-tip soft coagulation (STSC)—is used to burn the edges of the polyp area, targeting any leftover microscopic cells. STSC has been shown to cut the recurrence rate to around 10%. Now, a research team at the Montreal University Hospital Center (CHUM), led by Dr. Daniel von Renteln and Dr. Roupen Djinbachian, has developed a new technique that goes a step further. Instead of just burning the margins, this method uses an argon laser to burn the entire resection site, including both the margins and the base, to ensure that all microscopic polyp cells are destroyed. Preliminary results show that this new technique reduces recurrence to just 2%. This innovative approach has secured a major competitive research grant from the Canadian Institutes of Health Research to rigorously evaluate its effectiveness compared to the current standard of care.

A large, international randomized trial is now underway across centers in Canada, the USA, and Europe to compare this new argon laser method with STSC. If successful, this approach could revolutionize treatment for large polyps, offering patients a greater chance for a complete, curative resection during colonoscopy—potentially eliminating the need for further EMR procedures or even surgery, as well as chemotherapy.

Learn more about the trial here.