Hot avulsion: a modification of an existing technique for management of nonlifting areas of a polyp (with video).

Abstract

BACKGROUND:

Endoscopic management of the nonlifting areas of a colonic polyp is a significant challenge. The traditional approach has been to use ablative techniques with mixed long-term results.

OBJECTIVE:

To evaluate the safety and efficacy of hot avulsion (HA), a modification in the use of hot biopsy forceps in the management of the nonlifting areas of a colonic polyp.

DESIGN:

Retrospective review of data from a prospectively maintained colonic Endoscopic Mucosal Resection database.

SETTING:

Tertiary referral hospital.

PATIENTS AND INTERVENTION:

Twenty patients in whom HA was used as part of the polypectomy technique.

MAIN OUTCOME MEASUREMENTS:

Location and size of polyp, reasons for nonlifting, immediate success, residual rates, and adverse events.

RESULTS:

In our 20 patients studied, the main reasons for nonlifting were scarring from previous EMR attempts in 55% and scarring from previous biopsy in 35%. Mean size of avulsion was 4.4 mm (range, 1-15 mm). At the index procedure, HA was successful in removing macroscopic adenomatous tissue in all patients. At follow-up examinations, 85% (17/20) had no macroscopic or microscopic neoplasia residual and 15% (3/20) had a small area of residual that was easily treated with repeat HA. There were no immediate or long-term adverse events.

LIMITATIONS:

Nonrandomized, single-center experience.

CONCLUSIONS:

HA appears to be a safe and effective adjunct treatment to snare polypectomy for nonlifting areas of a colonic polyp. Further randomized multicenter studies are required with direct comparison to established techniques.

• Authors: Sundaram G Veerappan, Donald Ormonde, Ian F Yusoff, Spiro C Raftopoulos
• Journal: Gastrointestinal endoscopy (Gastrointest Endosc) Vol. 80 Issue 5 Pg. 884-8 (Nov 2014) ISSN: 1097-6779 [Electronic] United States
• PMID: 25065569 (Publication Type: Journal Article, Video-Audio Media)
• Copyright: Copyright © 2014. Published by Elsevier Inc.

Topics

• Adenomatous Polyps (surgery)
• Adult
• Aged
• Aged, 80 and over
• Colonic Neoplasms (surgery)
• Colonic Polyps (surgery)
• Colonoscopy (methods)
• Databases, Factual
• Dissection (methods)
• Electrosurgery (methods)
• Female
• Humans
• Intestinal Mucosa (surgery)
• Male
• Middle Aged
• Retrospective Studies