A blinded comparison of the safety and efficacy of hot biopsy forceps electrocauterization and conventional snare polypectomy for diminutive colonic polypectomy in a porcine model

Metz, Andrew J.; Moss, Alan; McLeod, Duncan; Tran, Kayla; Godfrey, Craig; Chandra, Abhilash P.; Bourke, Michael J.

doi:10.1016/j.gie.2012.09.014

Cited by 61 publications

(53 citation statements)

References 39 publications

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“…7 lesions were located in the caecum, 18 in the ascending colon, 5 in transverse colon, 4 in descending colon, 8 in sigmoid colon and 5 in the rectum. Histology revealed sessile serrated lesions (2), low grade dysplasia (27), high grade dysplasia (16) and intra-mucosal adenocarcinoma (2). Conclusion: This study shows that an EMR service can result in a significant reduction (approximately 50% in this cohort) in the total number of surgeries performed for primary indication of large polyp removal.…”

Section: Discussionmentioning

confidence: 83%

“…However, often, the incarcerated scope is usually the first sign of an inguinal hernia in a patient and in this situation the colonoscope should be reduced under direct fluoroscopic guidance with gentle manual pressure and adequate sedation, followed by an attempt at the 'pulley' system and finally, surgery, if all else fails. Unknown NA NA NA Punnam et al [10] Known, Left Failed manual reduction NA Withdrawal Surgical Dissection of Hernial Sac Lee et al [2] Unknown, Left Manual reduction NA Insertion Iser et al [11] Unknown, Left…”

Section: Resultsmentioning

confidence: 99%

“…Results: In the 4 years prior to the introduction of EMR, a total of 858 surgeries were undertaken of which 34 (17 male and 17 female) were performed for the primary indication of removing large colonic polyps. These were Abdominoperineal (AP) resection (2), Left hemicolectomy (2), Right hemicolectomy (21), sigmoid colectomy (7), and subtotal colectomy (2). Histology ranged from mild (10) and moderate (20) through to high grade (4) dysplasia.…”

Section: Discussionmentioning

confidence: 99%

“…In the subsequent 4 years, following introduction of EMR service, only 18 surgeries were performed for polyps: 14 R hemi-colectomies, 3 sigmoid colectomies and 1 subtotal colectomy. Surgical complications in these cohorts included prolonged ileus (3), pulmonary embolus (1), pneumonia (3), anastomotic bleed (3) and abscess (2). Between June 2008 to June 2012, 48 patients were referred for EMR.…”

Section: Discussionmentioning

confidence: 99%

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Endoscopy Lower

2013

J of Gastro and Hepatol

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Section: Discussionmentioning

confidence: 83%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Endoscopy Lower

2013

J of Gastro and Hepatol

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“…By applying endoscopic mucosal resection after repeated cold biopsies until no polyp tissue was visible, only 39% of the diminutive polyps were completely resected. Hot biopsy proved too dangerous in most hands [19]. A technique already published in the early 90s called ‘cold snaring' has been demonstrated in recent studies to be safe and effective [20,21].…”

Section: How To Resect Small and Diminutive Polypsmentioning

confidence: 99%

Small Colorectal Polyps

Schoefl

Ziachehabi

Wewalka³

2014

Dig Dis

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Small (<10 mm) and diminutive (<6 mm) polyps harbour high-grade dysplasia or cancer in 0.3-5% of cases. The potential to grow and develop advanced histology is low. Traditional guidelines still recommend the removal of all polyps. Visual characterisation with modern endoscopic technology could enable us to leave diminutive hyperplastic polyps in situ and remove but discard small polyps. In expert hands, high-definition white-light endoscopy and virtual chromoendoscopy can reach an accuracy of more than 90% in distinguishing between hyperplastic and adenomatous pathology. For less experienced endoscopists the values are lower and therefore the concept is not yet fit for routine use. Polyps can be removed completely with snares but not with forceps. The cold snaring technique in particular has proved safe and effective for small polyps. With more experience in the future a ‘cut and discard' strategy for small polyps and a ‘do not resect' strategy for diminutive polyps will save money and time to deal with more advanced lesions.

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Hot avulsion versus argon plasma coagulation for the management of the non‐ensnarable polyp: A multicenter, randomized controlled trial

Attree,

Ogra,

Yusoff

et al. 2024

JGH Open

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Background and AimSnare resection of nonlifting colonic lesions often requires supplemental techniques. We compared the success rates of neoplasia eradication using hot avulsion and argon plasma coagulation in colonic polyps when complete snare polypectomy had failed.MethodsPolyps that were not completely resectable by snare polypectomy were randomized to argon plasma coagulation or hot avulsion for completion of resection. Argon plasma coagulation was delivered using a forward shooting catheter, using a nontouch technique (flow 1.2 L, 35 watts). Hot avulsion was performed by grasping the neoplastic tissue with hot biopsy forceps and applying traction away from the bowel wall while using EndoCut I or soft coagulation for avulsion. Surveillance colonoscopies were performed at 6, 12, and 18 months.ResultsFrom November 2013 to July 2017, 59 patients were randomized to argon plasma coagulation (28) or hot avulsion (31). The median age was 69 (60–75), with 46% being female. The median residual tissue size was 10 mm (6–12). The residual adenoma rate at 6 months (hot avulsion 6% vs argon plasma coagulation 21% P = 0.09) and 18 months was not different between the groups (6.6% vs 3.6% P = 0.25). One patient in the argon plasma coagulation arm was diagnosed with metastatic cancer of likely colorectal origin despite benign histology in the original polypectomy specimen, supporting the importance of tissue acquisition.ConclusionBoth hot avulsion and argon plasma coagulation are effective and safe modalities to complete resection of non‐ensnarable colonic polyps.

show abstract

A blinded comparison of the safety and efficacy of hot biopsy forceps electrocauterization and conventional snare polypectomy for diminutive colonic polypectomy in a porcine model

Cited by 61 publications

References 39 publications

Endoscopy Lower

Endoscopy Lower

Small Colorectal Polyps

Hot avulsion versus argon plasma coagulation for the management of the non‐ensnarable polyp: A multicenter, randomized controlled trial

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