Endoscopic submucosal dissection of large pedunculated polyps with wide stalks: a retrospective multicenter study

Abstract

<jats:title>Abstract</jats:title><jats:p> Background Endoscopic resection of large pedunculated colorectal polyps is technically difficult, especially when the polyp is large and has such a thick stalk that it is either too difficult or impossible to resect prophylactically by a conventional snare. Here, we evaluated the feasibility of ESD for large pedunculated polyps with wide stalks.</jats:p><jats:p> Methods 29 patients with large pedunculated polyps that were not resectable by polypectomy or endoscopic mucosal resection were enrolled in the study.</jats:p><jats:p> Results En bloc resection was achieved in 28/29 polyps. One suspended case was due to severe fibrosis with muscle retraction signs. The mean diameter of the 29 polyp heads was 39.7 (standard deviation 6.9) mm. Submucosal fibrosis was present in 16 polyps (9 mild; 7 severe). The stalks of severely fibrotic polyps were significantly thicker than those of polyps with no or mild fibrosis. The curative resection rate was 85.7 % without severe complications.</jats:p><jats:p> Conclusions ESD is feasible for the removal of large pedunculated polyps with wide stalks when conventional snare resection is difficult or impossible.</jats:p>

Endoscopic submucosal dissection‐like grasping scissor forceps resection of a pedunculated colorectal lesion with high‐grade fibrosis complicating aborted hot snare polypectomy

“…In this setting utilization of such an ESD-like procedure may result in more convincing resection below the scarring line related to previous endoscopic removal attempt. [3][4][5] How to cite this article: Zimmer V, Eltze E. Endoscopic submucosal dissection-like grasping scissor forceps resection of a pedunculated colorectal lesion with high-grade fibrosis complicating aborted hot snare polypectomy. Adv Dig Med.…”

“…By contrast, re‐resection of previously aborted snare polypectomy has, to the best of my knowledge, not been reported before. In this setting utilization of such an ESD‐like procedure may result in more convincing resection below the scarring line related to previous endoscopic removal attempt 3–5 …”

Rapid upfront stalk transection for endoscopic resection of pedunculated colorectal lesions using a grasping-type scissor forceps

“…However, when larger, floppy polyps are present and/or the lesions are located in angulations, full endoscopic control of resection may not be guaranteed. Some groups have explored endoscopic submucosal dissection (ESD) for this purpose, and this is potentially of special relevance in cases of short-and wide-stalked lesions [2,3]. By contrast, a more simplified and less time-consuming approach, relying on scissor-type knives, has been reported as an endoscopic bailout after conventional technique failure [4].…”

Fatores de risco para eventos adversos em dissecção endoscópica de submucosa colorretal: revisão sistemática e meta-análise meta-an?lise

“…No entanto, a taxa de perfuração é maior com essa técnica [9][10][11][12]14] , bem como a necessidade de intervenção operatória devido a eventos adversos [12,15]. Dentre os eventos adversos encontrados na literatura, podemos destacar: eventos adversos em geral [17][18][19][20], perfuração [21][22][23][24][25][26][27][28][29][30] , sangramento [31][32][33][34][35], estenose [36][37][38] e síndrome pós-coagulação. [39][40][41].…”

“…Suzuki et al, lesões maiores tiveram uma tendência maior ao sangramento, porém esse achado não foi estatisticamente significativo[53]. Já para Chiba et al , lesões maiores do que 40 mm eram um fator de risco independente para sangramento[32] e para Seo et al as maiores do que 30 mm[31]. Não foi possível a extração de dados suficientes para realizar a meta-análise para esse fator de risco.…”