TY - JOUR
T1 - Hot avulsion: A modification of an existing technique for management of nonlifting areas of a polyp (with video)
AU - Veerappan, S.G.
AU - Ormonde, D.
AU - Yusoff, Ian
AU - Raftopoulos, S.C.
PY - 2014
Y1 - 2014
N2 - Copyright © 2014 by the American Society for Gastrointestinal Endoscopy. 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.
AB - Copyright © 2014 by the American Society for Gastrointestinal Endoscopy. 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.
U2 - 10.1016/j.gie.2014.05.333
DO - 10.1016/j.gie.2014.05.333
M3 - Article
SN - 0016-5107
VL - 80
SP - 884
EP - 888
JO - Gastrointestinal Endoscopy
JF - Gastrointestinal Endoscopy
IS - 5
ER -