New methodClinical endoscopySnare tip soft coagulation achieves effective and safe endoscopic hemostasis during wide-field endoscopic resection of large colonic lesions (with videos)
Section snippets
Methods
Between January 2011 and September 2012, a subgroup of patients referred for WF-EMR of AMN consented to participate in this observational cohort study. The study was approved by the hospital research ethics committee (SAC2010/5/4.9(3155) AU RED HREC/10/WMEAD/103). Patients were asked to withhold antiplatelet agents 7 days before the procedure. Anticoagulants were managed in accordance with current American Society for Gastrointestinal Endoscopy guidelines.4 Two senior endoscopists (MJB, SJW)
Results
A total of 198 lesions were removed in 196 patients (Table 1). The mean age was 68.0 years and 52.6% of patients were male. The mean lesion size was 41.5 mm (range 20-120 mm). Of the patients, 54.1% had lesions located in the right colon. Twenty-five (12.8%) and 6 (3.1%) patients were receiving antiplatelet and warfarin therapy, respectively. The mean time of cessation of aspirin, clopidogrel, and warfarin was 5, 6.5, and 4.3 days, respectively. Forty-seven patients (24.0%) had IPB. The
Discussion
Intraprocedural hemostasis is a highly relevant, yet underdocumented aspect of advanced endoscopic resection. In our cohort, IPB developed in 24% of patients undergoing WF-EMR for colonic AMN. Kim et al13 reported an immediate postpolypectomy bleeding (IPPB) rate of 2.8% in a cross-sectional study of an unselected cohort of 9336 polypectomies for colonic lesions larger than 4 mm. On multivariate analysis, polyp size greater than 10 mm, age 65 years and older, laterally spreading tumors, or
References (15)
- et al.
Endoscopic mucosal resection outcomes and prediction of submucosal cancer from advanced colonic mucosal neoplasia
Gastroenterology
(2011) - et al.
Large refractory colonic polyps: is it time to change our practice? A prospective study of the clinical and economic impact of a tertiary referral colonic mucosal resection and polypectomy service (with videos)
Gastrointest Endosc
(2009) - et al.
Management of antithrombotic agents for endoscopic procedures
Gastrointest Endosc
(2009) Endoscopic mucosal resection in the colon: a practical guide
Techn Gastrointest Endosc
(2011)- et al.
Wide field endoscopic resection for advanced colonic mucosal neoplasia: current status and future directions
Clin Gastroenterol Hepatol
(2012) - et al.
Electrosurgical generators: MAY 2003
Gastrointest Endosc
(2003) - et al.
The target sign: an endoscopic marker for the resection of the muscularis propria and potential perforation during colonic endoscopic mucosal resection
Gastrointest Endosc
(2011)
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2022, Gastrointestinal EndoscopyCitation Excerpt :All endoscopic procedures were performed by 1 of 5 study investigators (accredited gastroenterologist with advanced training and an established tertiary referral practice in colorectal endoscopic resection) or a senior interventional endoscopy fellow under their direct supervision. EMR was performed with a standardized technique that was modified over time as technical innovations emerged.12-17 After endoscopic resection, specimens were collected and processed for histopathology review in accordance with the Australasian Gastrointestinal Pathology Society guidelines.18
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2022, Clinics in Liver DiseaseCitation Excerpt :In the mid-1950s, EMR technique was first introduced as a method whereby a saline solution was injected into the submucosal space under the lesion, creating a safety cushion whereby the lesion could then be removed in a single resection or by piecemeal fashion.1 EMR techniques evolved over time and now include standard EMR, underwater EMR, and snare tip soft coagulation EMR.2,3 In contrast, ESD techniques allow en bloc resection of the lesion after careful dissection of the submucosal space.
DISCLOSURE: The authors disclosed no financial relationships relevant to this publication.
If you would like to chat with an author of this article, you may contact Dr Bourke at [email protected].