Clip artifact after closure of large colorectal EMR sites: incidence and recognition

Sreepati, Gouri; Vemulapalli, Krishna C.; Rex, Douglas K.

doi:10.1016/j.gie.2014.12.059

Cited by 26 publications

(17 citation statements)

References 5 publications

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“…The presence of ESCA is not associated with the size of the defect, location or histology of the removed polyp, which is consistent with the study published by Sreepati et al 11 . They also found that the number of clips used was related to the presence of ESCA, which could not be confirmed in this study.…”

Section: Discussionsupporting

confidence: 92%

“…The apposition of the defect margins with clips may determine a new appearance of the scar leading to difficulty in the assessment of recurrence. This has recently been described as "clip artifact," a bumpy scar that has a normal pit pattern and that is normal on biopsy 11 . In this article, we aimed to systematically analyze and describe the appearance of scars formed after closure of EMR defects and identify the risk factors associated with ESCA.…”

Section: Introductionmentioning

confidence: 99%

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The influence of clips on scars after EMR: clip artifact

Pellisé

Desomer

Burgess

et al. 2016

Gastrointestinal Endoscopy

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

The influence of clips on scars after EMR: clip artifact

Pellisé

Desomer

Burgess

et al. 2016

Gastrointestinal Endoscopy

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“…In a number of previous studies on polyp resection from our center, we reported only non-pedunculated lesions at least 20 mm in size. [16][17][18][19][20] However, in the current study it seemed reasonable to include all referred polyps. These data show that a substantial fraction of nonpedunculated colorectal lesions referred to a tertiary center are <20 mm in maximum dimension.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Safety and efficacy of hot avulsion as an adjunct to EMR (with videos)

Kumar

Broadley

Rex

2019

Gastrointestinal Endoscopy

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Background: Excision of all visible neoplastic tissue is the goal of endoscopic mucosal resection (EMR) of colorectal laterally spreading tumors (LSTs). Flat and fibrotic tissue can resist snaring. Ablation of visible polyps is associated with high recurrence rates. Avulsion is a technique to continue resection when snaring fails. Methods: We retrospectively analyzed colonic EMRs of 564 consecutive referred polyps between 2015 and 2017. Hot avulsion was used when snaring was unsuccessful. Polyps treated with and without avulsion were compared. Results: Hot avulsion was used in 20.9% (n=112) of all resected lesions. The recurrence rates on follow up colonoscopy were 17.52% in avulsion group versus 16.02% in the non-avulsion group (p= 0.76). Hot avulsion was associated with a trend toward higher rates of delayed hemorrhage (5.35% vs 2.58%; p=0.15) and post-coagulation syndrome (1.8% vs 0.47%; p=0.15), but polyps treated with any avulsion were larger than those in which no avulsion was used (p=<0.001). There were an insufficient number of adverse events to perform a multivariable analysis testing the effects of avulsion, size, and location on the risk of overall adverse events. Conclusion: Unlike previous reports of using argon plasma coagulation to treat visible polyp during EMR, hot avulsion of visible/fibrotic neoplasia was associated with similar EMR efficacy compared with cases that did not require hot avulsion. The safety profile of hot avulsion appears acceptable.

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“…Previous studies have shown that clip artifact was associated with a higher number of clips used. 10 In the study by Pellisé et al, 11 clips placed as prophylaxis of postprocedural bleeding were more often associated with clip artifact than were those placed for treatment of intraprocedural bleeding or deep muscularis propia injury. The authors speculate that this may occur because closing the whole mucosal defect may result in significant tissue tension as the edges are drawn together, probably requiring more clips.…”

mentioning

confidence: 97%

“…In a retrospective study including 303 post-EMR defects that were clipped to decrease postpolypectomy bleeding, Dr. Rex's group from Indiana University Hospital showed that approximately 32% of the scars, at a 6-month surveillance colonoscopy, had bumps of tissue on or adjacent to the scar. 10 This so-called clip artifact coexisted with recurrence in a few cases. The authors stated that clip artifact was reliably differentiated from overt residual polyp by its endoscopic appearance.…”

mentioning

confidence: 99%