Original articleClinical endoscopyCold snare piecemeal EMR of large sessile colonic polyps ≥20 mm (with video)
Section snippets
Methods
This study was approved by the Western Health Research Ethics Committee. We performed a retrospective multicenter review of all CSP-EMR procedures at 5 Australian academic hospitals for sessile polyps ≥20 mm over 2 years, from January 2016 to December 2017. Lesions were assessed using high-definition white-light imaging (HD-WLI) and narrow-band imaging (NBI). We recorded polyp overall morphology using the Paris classification,22 surface morphology (granular, nongranular, or mixed),23 and Kudo
Results
Over a 24-month period (January 2016 to December 2017), CSP-EMR was performed on 204 lesions (mean, 25.5 mm [standard deviation, 8.4]; median, 20 mm [IQR, 20-30]) in 186 patients (63 men [33.8%]; median age, 68 years [range, 21-91]). Ninety-two polyps (44%) were ≥25 mm, 61 (29.6%) ≥30 mm, and 19 (9.2%) ≥40 mm. One hundred eighty-nine polyps (92.6%) were from the proximal colon (proximal to the splenic flexure) and 15 polyps (7.4%) were from the distal colon (distal to the splenic flexure). The
Discussion
Colorectal EMR is a safe, effective, and less-invasive alternative to surgery.1,28 However, electrocautery use during EMR exposes patients to risks, including perforation, PPS, and clinically significant post-EMR bleeding. Avoidance of thermal energy when feasible can reduce these risks. To our knowledge, this is the largest study investigating safety and efficacy outcomes for CSP-EMR of large sessile (≥20 mm) colonic polyps. Our study of 186 patients with 204 polyps demonstrates that CSP-EMR
References (32)
- et al.
Endoscopic mucosal resection outcomes and prediction of submucosal cancer from advanced colonic mucosal neoplasia
Gastroenterology
(2011) - et al.
Outcomes of EMR of defiant colorectal lesions directed to an endoscopy referral center
Gastrointest Endosc
(2012) 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.
How to perform high-quality endoscopic mucosal resection during colonoscopy
Gastroenterology
(2017) - et al.
A comparison of depth of tissue injury caused by different modes of electrosurgical current in a pig colon model
Gastrointest Endosc
(2004) - et al.
Endoscopic snare excision of "giant" colorectal polyps
Gastrointest Endosc
(1996) - et al.
Endoscopic piecemeal resection with submucosal saline injection of large sessile colorectal polyps
Gastrointest Endosc
(2000) - 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) - 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)
Cold EMR of large sessile serrated polyps at colonoscopy (with video)
Gastrointest Endosc
Clinicopathologic features and endoscopic treatment of superficially spreading colorectal neoplasms larger than 20 mm
Gastrointest Endosc
The management of antithrombotic agents for patients undergoing GI endoscopy
Gastrointest Endosc
Actual endoscopic versus predicted surgical mortality for treatment of advanced mucosal neoplasia of the colon
Gastrointest Endosc
Prophylactic endoscopic coagulation to prevent delayed postendoscopic mucosal resection bleeding in the colorectum: a prospective randomized controlled trial (with videos)
Gastrointest Endosc
Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline
Endoscopy
Cited by (0)
DISCLOSURE: Dr Brown: Research support from Olympus Australia. Dr Raftopoulos: Lecture fees and research support from Olympus Medical. All other authors disclosed no financial relationships.
See CME section; p. 1378.
If you would like to chat with an author of this article, you may contact Dr Moss at [email protected].