Endoscopic treatment of sessile rectal adenomas: Comparison of Nd:YAG laser therapy and injection-assisted piecemeal polypectomy

Argon Plasma Coagulation after Piecemeal Polypectomy of Sessile Colorectal Adenomas: Long-Term Follow-Up Study

“…A variety of methods other than APC have been used to improve the results of piecemeal polypectomy of large colorectal adenomas: immediate fulguration of visible adenomatous remnants with the tip of a diathermic snare [3] or with a monopolar probe [7]; delayed electrocoagulation of postpolypectomy site 3 ± 4 weeks after polypectomy [4]; injection-assisted polypectomy [6,8,10,13]; or Nd:YAG laser used in combination with snare polypectomy [14 ± 16] or in monotherapy [17]. The adenoma recur-rence rate in these studies ranged from 0 % to 43 % and was usually higher than in the present study.…”

Systematic review of endoscopic mucosal resection versus transanal endoscopic microsurgery for large rectal adenomas

“…Most other EMR studies (n = 15) reported recurrences on colorectal adenomas without specifying colonic location [24,26 -28,30,31,33 -39,42,43]. Two EMR studies did not report any data on recurrence [29,40]. As only one EMR study adequately reported recurrence rates for adenomas of the rectum only, this study was described separately.…”

“…For the pooled random effects model, EMR studies reporting on colorectal adenomas were included in the analysis as well. In 38 out of the 48 TEM case series, it was possible to extract recurrence data of patients with rectal adenomas [4,7,29,48 In total, 3890 patients (EMR 1030 and TEM 2860) were included for the analyses of recurrences. The pooled estimate of the proportion of patients with early adenoma recurrence in the EMR studies was 11.2 % (95 %CI 6.0 -19.9) vs. 5.4 % (95 %CI 4.0 -7.3) in the TEM studies (P = 0.04) (• " Fig.2).…”

Improved Techniques for Endoscopic Mucosal Resection (EMR) in Colorectal Adenoma

“…In the first polypectomy described, mucosal elevation was created by injections in order to avoid thermal injury to the deeper tissue layers [ 1 , 3 ]. In larger and flat lesions, the problem is that the applied liquid quickly spreads to the surrounding tissue and the raised mucosa flattens before complete resection can be performed [ 9 ].…”

“…Endoscopic polypectomy was first described over 40 years ago [ 1 , 2 ]. Even at this first snare resection, a submucosal injection with saline was performed for better handling of the snare and prevention of perforation and thermal damage to the deeper tissue layers [ 1 , 3 ]. This combination of endoscopic snare resection with preceding mucosal injection quickly became the standard method for the treatment of polyps and adenomas, and Inoue et al [ 4 ] and Soehendra et al [ 5 ] coined the term ‘endoscopic mucosal resection’ (EMR) for flat lesions.…”