Project description:Background and study aims Small colorectal polyps are removed by various methods, including cold snare polypectomy (CSP), hot snare polypectomy (HSP), and underwater endoscopic mucosal resection (UEMR), but the indications for using these methods are unclear. We retrospectively assessed the efficacy of CSP, HSP, and UEMR for small polyps, focusing on the depth of the resected specimens. Patients and methods Outpatients with non-pedunculated small polyps (endoscopically diagnosed as 6 to 9 mm), resected by two endoscopists between July 2019 and September 2020, were enrolled. We histologically evaluated the specimens resected via CSP, HSP, and UEMR. The main outcome was the containment rate of the muscularis mucosa (MM) and submucosa (SM) tissues. Results Forty polyps resected via CSP (n = 14), HSP (n = 12), or UEMR (n = 14) were enrolled after excluding 13 polyps with resection depths that were difficult to determine. The rates of specimens containing MM and SM tissue differed significantly (57 % and 29 % for CSP, 92 % and 83 % for HSP, and 100 % and 100 % for UEMR, respectively ( P = 0.005 for MM and P < 0.001 for SM tissue). Multiple logistic regression analysis showed UEMR was an independent factor relating to the containment of SM tissue. The thickness of SM tissue by CSP, HSP, and UEMR were 52 μm, 623 μm, and 1119 μm, respectively ( P < 0.001). The thickness by CSP was significantly less than those by HSP and UEMR ( P < 0.001, Bonferroni correction). Conclusions UEMR could be the best method to contain SM tissue without injection. Further studies are needed to evaluate the indication of UEMR for small polyps.

| S-EPMC9106413 | biostudies-literature

Cold snare piecemeal resection of colonic and duodenal polyps ≥1 cm.

Project description:Endoscopic removal of duodenal and colorectal adenomas is currently considered to be the standard of care for prevention of adenocarcinoma. The use of cautery carries a risk of delayed bleeding, post-polypectomy syndrome, and perforation. We examined the safety and feasibility of removing colonic and duodenal polyps ≥ 1 cm using a piecemeal cold snare polypectomy technique.The study included 15 patients with duodenal polyps ≥ 1 cm and 15 patients with colonic polyps ≥ 1 cm.Bleeding, perforation, abdominal pain, or hospitalization occurring within 2 weeks of polypectomy.Between 24 August 2011 and 29 April 2013, 15 patients had removal of duodenal polyps ≥ 1 cm. Mean patient age was 64 years and 9/15 patients were male. The mean polyp size was 24 mm (10 - 60 mm). All polyps were removed with a cold snare and some required cold biopsy forceps. One patient required hospitalization for gastrointestinal blood loss 7 days post-polypectomy; this patient was using Coumadin. Between 27 February 2012 and 30 May 2013, 15 patients underwent resection of a ≥ 1 cm colonic polyp. Mean patient age was 68 years and 9/15 were male. The mean polyp size was 20 mm (10 - 45 mm). All polyps were primarily removed with a cold snare. None of the patients required hemostatic clips for control of immediate bleeding. One patient presented to the emergency department with abdominal pain 1 day after initial endoscopy. CT scan showed no abnormalities and the patient was discharged.Cold snare polypectomy for large duodenal and colonic polyps is technically feasible and may have a favorable safety profile compared to standard electrocautery-based endoscopic resection. Comparative trials are required to determine the relative safety and efficacy of cold snare techniques for complete and durable resection of large polyps compared to standard hot snare methods.

| S-EPMC4612226 | biostudies-other

Traction-assisted endoscopic mucosal resection for polypectomy in the large intestine.

Project description:AimTo evaluate if traction-assisted endoscopic mucosal resection (TA-EMR) is feasible and if it enables en bloc resection of colorectal lesions.MethodsSeven patients with a total of 12 colorectal adenomas were prospectively enrolled. All lesions were removed by TA-EMR: one hemostatic clip tied to a white silk suture was applied to the base of the lesion to allow traction through the working channel of the colonoscope. A conventional polypectomy snare was mounted over the suture and the lesion was pulled into the snare and resected in one piece.ResultsAll 12 lesions (nine sessile) were resected en bloc with free lateral and vertical margins by using this novel technique, including five lesions (5/12, 41.6%) in less-accessible positions, where TA-EMR enabled complete visualization of the base before resection. Mean longest lesion and specimen sizes were 9 mm (range: 6-25 mm) and 11 mm in diameter (range: 7-17 mm), respectively. No serious procedure-related complications were observed.ConclusionTA-EMR through the endoscope using a hemostatic clip and suture material is technically feasible. Visualization of colorectal lesions in less-accessible locations can be improved.

| S-EPMC2988240 | biostudies-literature

Cold Snare Polypectomy Versus Endoscopic Mucosal Resection for Colonic Sessile Serrated Polyps

Project description:Comparing the efficacy of cold snare polypectomy with endoscopic mucosal resection

| 2230090 | ecrin-mdr-crc

A Novel Bipolar Polypectomy Snare Can Be an Alternative Choice for Endoscopic Resection.

Project description:Objective: Endoscopic resection (ER) is more difficult and has a higher rate of complications, such as perforation and bleeding. The aim of this study was to evaluate the safety and feasibility of a bipolar polypectomy snare for ER. Methods: Initial ER procedures in live pigs were carried out. Then, a human feasibility study was performed in patients with colorectal polyps. Finally, the finite element method was used to evaluate the safety and effectiveness of the new bipolar snare. Results: In the live animal model, there were no significant differences in wound size and cutting time between monopolar and bipolar groups. The histological results (histological scores) of the two groups in porcine experiments were almost the same except that the incision flatness of bipolar group was better than that of the monopolar group. Incidence of bleeding and perforation was similar between the two groups in pigs' and patients' study. At last, the finite element model showed that the vertical thermal damage depth produced by bipolar snare system was approximately 71-76% of that produced by monopolar snare system at the same power. Conclusions: The novel bipolar snare is feasible in patients with colorectal polyps and can be an alternative choice for ERs.

| S-EPMC7855578 | biostudies-literature

New inversion method: endoscopic submucosal dissection of a neoplasm extending into a colonic diverticulum.

Project description: Not available

| S-EPMC6492311 | biostudies-literature

Cold Snare Polypectomy

Project description:During colonoscopy, the endoscopist will document prospectively all polyps detected and note the size, location and morphology. Polyps of 4-20 mm will be removed only in accordance with the method the cold snare. Afterwards, the remaining tissues could be observed with an imaging technology called Optivista with an injection of 10-50 ml of saline solution (if required) to improve visibility of the tissues. The endoscopist will continue to remove the remaining polyp tissue (with a snare or forceps) until there are no more visible polyp tissues. Biopsies from the polyp resection site will be sent to the laboratory for analysis to confirm the complete resection.

| 2271138 | ecrin-mdr-crc

Successful endoscopic submucosal dissection for a tumor located completely within a colonic diverticulum after inversion of the diverticulum using a traction device.

Project description:Video 1Successful endoscopic submucosal dissection for a tumor completely located within a colonic diverticulum after inversion of the diverticulum using a traction device. After reconfirming that the diverticulum could be inverted into the lumen with forceps, the first endoclip grasping a ring-thread made of dental floss was fixed on the mucosa in the diverticulum. Immediately afterward, a second endoclip was used to grasp the ring-thread and fix it to the opposite colonic wall. By insufflating with air, the lesion within the inverted diverticulum was pulled out of the diverticulum into the colonic lumen, establishing a good field of view for dissection. After local injection of hyaluronic acid, a circumferential incision and dissection were performed using a DualKnife, and the lesion was promptly removed en bloc. The wound was completely closed with endoclips, along with the diverticulum. The total procedure time was 10 minutes, and there were no adverse events.

| S-EPMC8645970 | biostudies-literature

Successful 2-channel cold snare polypectomy of a colorectal lesion involving the appendiceal orifice.

Project description: Not available

| S-EPMC6119232 | biostudies-literature