Implementation of ESGE Recommendations on Margin Thermal Ablation After EMR: Preliminary results from the TABLE Multicentre Real-World Study

Aims Margin thermal ablation (MTA) following endoscopic mucosal resection (EMR) of large non-pedunculated colorectal lesions has been shown to markedly reduce recurrence in studies conducted in tertiary referral centres after dedicated training in the ablation technique, and is now recommended by ESGE (2024). However, data on real-life implementation across centres with variable case volumes and expertise, including referral units, are limited. This study aimed to evaluate the feasibility, safety and early outcomes of MTA in a multicentre routine-practice setting . Methods This was a prospective multicentre observational study conducted across 14 Italian endoscopy units performing therapeutic colonoscopy. Consecutive patients undergoing EMR for colorectal lesions≥20 mm were included. Demographic, lesion and procedural characteristics, completeness of MTA, and peri- and post-procedural adverse events were collected. Surveillance was planned according to European guidelines and local recurrence was assessed endoscopically. The primary endpoint was the feasibility of MTA in routine practice, while secondary endpoints included local recurrence and the occurrence of adverse events. Results A total of 498 patients with 517 lesions were included (mean age 70.0±10.4 years; 54.9% male). Most lesions were proximal (76.1%) and classified as level 3–4, according to the Size–Morphology–Site–Access scoring system (SMSA).Piecemeal EMR was performed in 80.1% of cases, yielding 98.2% of complete resections, while en-bloc resection was achieved in 19.9%. Overall, MTA was applied in 66.9% of lesions, including 50%, 72.6%, and 96.2% of en-bloc, piecemeal, and complete piecemeal EMR, respectively. Complete MTA was achieved in 91.4% of complete piecemeal resections. Adverse events occurred in 12.4% (intraprocedural bleeding 8.9%, intraprocedural perforation 1.0%, delayed bleeding 2.3%, delayed perforation 0.2%), consistent with expected EMR risks. Follow-up was available for 332 lesions (64.2%). Overall recurrence was 15.7%, with substantial inter-centre heterogeneity (0–35%). Recurrence after complete piecemeal EMR with complete MTA was 14.5% (0–24.2% across centres) versus 26.4% (0–45.5%) following incomplete or omitted MTA (p=0.02). Incomplete/omitted MTA was more frequent in SMSA 4, lesions≥40 mm, and proximal locations [ 1 ] [ 2 ] [ 3 ] [ 4 ]. Conclusions MTA was feasible and widely adopted across centres with different procedural volumes and expertise. Nonetheless, its effectiveness varied according to lesion complexity. The marked inter-centre heterogeneity in both adoption and outcomes highlights the impact of operator experience and local workflows, reinforcing the need for harmonised protocols, competency-based training and standardised ablation techniques to ensure consistent performance and optimise recurrence reduction across different practice settings. Publication History Article published online: 05 June 2026 © 2026. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany