Thermal ablation of the resection base after endoscopic mucosal resection: a useful tool when perfect technique is not achievable

We welcome the excellent discussion from Mandarino et al regarding whether thermal ablation of resection base is warranted after endoscopic mucosal resection (EMR) of large non-pedunculated colorectal polyps.1 2 We agree with many of the points raised by the authors.

Indeed, a perfect resection technique as evidenced by Mandarino et al is likely to reduce the need for base ablation; however, such perfect technique is not always possible be it due to polyp-related or endoscopist-related factors. Furthermore, perfect overlapping resections with wide margins would also theoretically preclude the need for snare tip soft coagulation (STSC) of the margins. However, if the theory of microscopic polyp remnants at the margins despite overlapping and wide resection holds true, then the same should be considered possible for the base. Several Randomised controlled trials (RCTs) comparing hot versus cold snare EMR have recently been presented.3 4 Cold snare consistently …

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