Outcomes of Thermal Ablation of the Mucosal Defect Margin After Endoscopic Mucosal Resection: A Prospective, International, Multicenter Trial of 1000 Large Nonpedunculated Colorectal Polyps

Sidhu, Mayenaaz; Shahidi, Neal; Gupta, Sunil; Desomer, Lobke; Vosko, Sergei; Hattem, W. Arnout van; Hourigan, Luke F.; Lee, Eric Y.T.; Moss, Alan; Raftopoulos, Spiro; Heitman, Steven J.; Williams, Stephen J.; Zanati, Simon; Tate, David J.; Burgess, Nicholas G.; Bourke, Michael J.

doi:10.1053/j.gastro.2021.03.044

Cited by 81 publications

(73 citation statements)

References 25 publications

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“…Three studies originated from USA, one from Greece and two from Australia. Both studies from Australia were multicenter prospective trials with different study periods i. e. July 2013 – May 2016 15 and May 2016 – August 2020 16 . There was no overlap of patient cohorts in these studies as confirmed by the study authors.…”

Section: Resultsmentioning

confidence: 99%

“…Pooled incidence of intraprocedural bleeding (IPB) after STSC – defined as bleeding that persisting for 30 seconds and requiring endoscopic control, achieved with snare tip soft coagulation (STSC) or coagulation graspers, 15 or mechanical hemostasis 16 or as oozing or spurting of blood persisting for longer than 60 s and not responding to water jet irrigation 17…”

Section: Methodsmentioning

confidence: 99%

“…Pooled incidence of delayed bleeding (DB) after STSC – defined as any bleeding which occurred after the procedure and required emergency room presentation, hospitalization, or re-intervention (endoscopy, angiography, surgery) within 14 days 15 16 or passage of fresh blood per rectum within the following 2 weeks after the procedure 18 .…”

Section: Methodsmentioning

confidence: 99%

“…The supplementary outcomes were as follows: 1. Pooled incidence of intraprocedural bleeding (IPB) after STSCdefined as bleeding that persisting for 30 seconds and requiring endoscopic control, achieved with snare tip soft coagulation (STSC) or coagulation graspers, [15] or mechanical hemostasis [16] or as oozing or spurting of blood persisting for longer than 60 s and not responding to water jet irrigation [17] 2. Pooled incidence of delayed bleeding (DB) after STSCdefined as any bleeding which occurred after the procedure and required emergency room presentation, hospitalization, or re-intervention (endoscopy, angiography, surgery) within 14 days [15,16] or passage of fresh blood per rectum within the following 2 weeks after the procedure [18].…”

Section: Supplementary Outcomesmentioning

confidence: 99%

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Snare tip soft coagulation (STSC) after endoscopic mucosal resection (EMR) of large (> 20 mm) non pedunculated colorectal polyps: a systematic review and meta-analysis

et al. 2022

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Background and study aims Endoscopic mucosal resection (EMR) of laterally spreading tumors (LSTs) > 20 mm in size can be challenging. Piecemeal EMR of these lesions results in high rates of adenoma recurrence at first surveillance colonoscopy (SC1). Snare tip soft coagulation (STSC) of post resection margins is a safe and effective technique to prevent adenoma recurrence. We conducted a systematic review and meta-analysis to evaluate the effectiveness and safety of this technique. Patients and methods Multiple databases were searched through April 2021 for studies that reported on outcomes of post EMR STSC for LSTs > 20 mm in size. Meta-analysis was performed to determine pooled odds of adenoma recurrence as well as pooled proportion of adverse events including intraprocedural and delayed bleeding as well as intraprocedural perforation events. Results Six studies including two randomized controlled trials (RCT) and four cohort studies with 2122 patients were included in the final analysis. Overall pooled odds of adenoma recurrence at SC1 with post EMR STSC compared to no STSC was 0.27 (95 % 0.18–0.42; I2 = 0 %), P < 0.001. Pooled rate of adenoma recurrence at SC1 in post EMR STSC cohort was 6 %. Rates of intraprocedural bleeding, delayed bleeding and intraprocedural perforation were 10.3 %, 6.5 % and 2 % respectively. Conclusions Our results show that thermal ablation of resection margins with STSC in LSTs > 20 mm is a safe and effective technique in reducing the incidence of adenoma recurrence.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Supplementary Outcomesmentioning

confidence: 99%

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Snare tip soft coagulation (STSC) after endoscopic mucosal resection (EMR) of large (> 20 mm) non pedunculated colorectal polyps: a systematic review and meta-analysis

et al. 2022

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“…After resection, post-EMR defect margins were prophylactically treated with snare tip soft coagulation to help prevent recurrence. 3,4 To reduce the risk of delayed AEs, closure of the EMR defect with endoscopic clips was attempted. Because of the large size of the resection bed, complete apposition of the 2 edges of the mucosal defect using standard endoscopic clips was not feasible.…”

Section: Case Presentationmentioning

confidence: 99%

Rubber band-assisted closure of a mucosal defect following duodenal EMR

2021

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EMR of large duodenal adenomas is a technically challenging procedure. It carries a particularly high risk of perforation (5 % -10%) because of its relatively thin and fixed wall and delayed bleeding (15%) due to its rich vascular supply. 1 Systematic closure of mucosal defects after duodenal endoscopic resection has been found to significantly reduce the risk of delayed adverse events (AEs) by 80%, specifically the risk of delayed bleeding and perforation. 2 However, owing to the fixed retroperitoneal descending duodenum, apposition of the 2 mucosal edges is not always feasible, making closure using standard clips challenging. We describe a simple and safe technique using an inexpensive and widely available rubber band and standard endoscopic clips (Video 1, available online at www.giejournal.org). TECHNIQUEThis technique requires the use of a commercially available orthodontic rubber band (Fig. 1A) in addition to Figure 1. A, Rubber band used for closure. B, Rubber band is placed on 1 clip arm. C, Clip is closed securely. D, Clip with the attached rubber band is inserted into the endoscope instrument channel.

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