Abstract | BACKGROUND: There are few randomized studies examining efficacy of snares and agents in EMR. OBJECTIVE: DESIGN: Prospective, randomized, factorial, single center. SETTING: Tertiary-care academic medical center. PATIENTS: A total of 140 patients with large (>15 mm), sessile, colorectal polyps. INTERVENTIONS:
Polyps randomized to either 1 of 2 snare types and 1 of 2 injectates. MAIN OUTCOME MEASUREMENTS: Primary-the Sydney resection quotient (SRQ), defined as the size of the polyp divided by the number of pieces resected and the amount of tissue per snare attempt. Secondary-procedure time, adverse events, residual neoplasia at follow-up. RESULTS: The SRQ was higher with the combined unit (median 13.8 mm vs 7.1 mm; P = .019); additionally, procedure time was less (median 6 vs 11 minutes; P < .001). Resection was considered complete after the EMR in 62% (42/68) with the combined needle and snare unit versus 51% (37/72; P = .22) with the spiral wire. Rates of adverse events were similar. Residual neoplasia was found at follow-up in 22% (10/46) with the combined needle and snare unit versus 21% (10/48; P = .89) with the spiral wire. There was no evidence of differences in outcomes by lifting agent. LIMITATIONS: CONCLUSION: This study provides evidence that the integrated needle-snare may be superior to the snare alone for the removal of large, flat polyps. Additionally, the type of injectate appears to have no impact on outcome.
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Authors | Timothy Woodward, Julia E Crook, Massimo Raimondo, Michael Wallace |
Journal | Gastrointestinal endoscopy
(Gastrointest Endosc)
Vol. 81
Issue 3
Pg. 673-81
(Mar 2015)
ISSN: 1097-6779 [Electronic] United States |
PMID | 25708754
(Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Video-Audio Media)
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Copyright | Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved. |
Topics |
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Colonic Polyps
(surgery)
- Colonoscopy
(instrumentation, methods)
- Female
- Follow-Up Studies
- Humans
- Intestinal Mucosa
(surgery)
- Male
- Middle Aged
- Prospective Studies
- Treatment Outcome
- Young Adult
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