A new AGA clinical practice update is pushing endoscopists to think beyond generator dials. While electrosurgical units (ESUs) are a staple of therapeutic GI endoscopy, the update makes clear that outcomes are shaped by the interplay of device settings, operator technique, tissue composition, and procedural environment — not any single factor in isolation. Notably, the evidence shows no meaningful difference in major outcomes between cut-predominant and coagulation-predominant currents for colorectal polypectomy, shifting the focus toward individualized, real-time decision-making rather than protocol-driven defaults.
The update also elevates two practical priorities: hot snare remains the preferred approach for large pedunculated polyps due to its vessel-sealing advantage, and thermal margin ablation after piecemeal EMR — using either snare tip soft coagulation or argon plasma coagulation — can reduce recurrence rates to under 5%. Safety considerations round out the guidance, with particular attention to patients with implanted cardiac devices and the underappreciated risk of delayed perforation from overzealous soft coagulation.
For GI proceduralists and practice leaders, the message is less about which current type to choose and more about building the team-based awareness and technical precision that modern ESU capabilities demand.
In electrosurgery, the generator is only as safe as the hands — and the judgment — behind it.