Improving Safety in Polyp Removal: The Closure Trial

Colorectal cancer often starts as a small polyp that slowly grows until it becomes cancerous. Research indicates that once a polyp reaches around 20mm in size, it can rapidly progress to cancer. Removing these larger polyps early is essential for preventing cancer and avoiding major treatments like surgery or chemotherapy.

During a colonoscopy, physicians perform an advanced procedure known as Endoscopic Mucosal Resection (EMR) to remove large polyps. In this procedure, the doctor injects fluid to lift the polyp off the colon wall and then removes it piece by piece using a snare. While EMR is generally effective, complications such as bleeding and small perforations occur in about 10% of patients. Although this rate is lower than that seen with surgery, reducing these complications is important to ensure a safe prevention strategy for colorectal cancer.

A research team at the Montreal University Hospital Center (CHUM), led by Dr. Daniel von Renteln and Dr. Roupen Djinbachian, has proposed a new approach to enhance the safety of EMR. They suggest that using specially designed clips to close the resection site after EMR may reduce complications. 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 at centers in Canada, the USA, and Europe to compare this clip closure strategy with the current standard, where the resection site is not routinely closed. If successful, this innovative approach could transform the treatment of large polyps, offering patients a safer method for removal and significantly reducing the risk of adverse outcomes.

Learn more about this trial here.