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

Kumar, Vinod; Broadley, Heather M.; Rex, Douglas K.

doi:10.1016/j.gie.2018.11.032

Cited by 29 publications

(26 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…After EMR of large polyps, residual neoplasia should be excised using hot and cold avulsion 17 . Use of thermal ablation of visible residual neoplasia is a strong predictor of recurrence 16,18 .…”

Section: B Superficial Neoplasia At Risk Of Submucosal Invasion After Resectionmentioning

confidence: 99%

When and How To Use Endoscopic Tattooing in the Colon: An International Delphi Agreement

Medina-Prado

Hassan

Dekker

et al. 2021

Clinical Gastroenterology and Hepatology

Self Cite

View full text Add to dashboard Cite

Section: B Superficial Neoplasia At Risk Of Submucosal Invasion After Resectionmentioning

confidence: 99%

When and How To Use Endoscopic Tattooing in the Colon: An International Delphi Agreement

Medina-Prado

Hassan

Dekker

et al. 2021

Clinical Gastroenterology and Hepatology

Self Cite

View full text Add to dashboard Cite

“…A total of 21 studies employed EMR, including eight studies with analysable data (381 lesions) on the R0 resection rate and 16 studies with analysable data (814 lesions) on the en bloc resection rate. [ 8 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 ] The pooled proportions for R0 resection rate and en bloc resection rate were 87% (95% CI 0.75–0.93, I 2 = 83%) and 88% (95% CI 0.79–0.93, I 2 = 89%), respectively.…”

Section: Resultsmentioning

confidence: 99%

Effectiveness and safety of the different endoscopic resection methods for 10- to 20-mm nonpedunculated colorectal polyps: A systematic review and pooled analysis

Yuan

Gao

Liu

et al. 2021

Saudi J Gastroenterol

View full text Add to dashboard Cite

Background: We performed a systematic review and pooled analysis to assess the effectiveness and safety of different endoscopic resection methods for 10- to 20-mm nonpedunculated colorectal polyps. Methods: Articles in PubMed, EMBASE, and the Cochrane Library related to the common endoscopic treatment of 10- to 20-mm nonpedunculated polyps published as of April 2020 were searched. Primary outcomes were the R0 resection rate and en bloc resection rate. Secondary outcomes were safety and the recurrence rate. Meta-regression and subgroup analysis were also performed. Results: A total of 36 studies involving 3212 polyps were included in the final analysis. Overall, the effectiveness of resection methods with a submucosal uplifting effect, including endoscopic mucosal resection (EMR), cold EMR and underwater EMR (UEMR), was better than that of methods without a nonsubmucosal uplifting effect [R0 resection rate, 90% (95% confidence interval (CI) 0.81–0.94, I 2 = 84%) vs 82% (95% CI 0.78–0.85, I 2 = 0%); en bloc resection rate 85% (95% CI 0.79–0.91, I 2 = 83%) vs 74% (95% CI 0.47–0.94, I 2 = 94%)]. Regarding safety, the pooled data showed that hot resection [hot snare polypectomy, UEMR and EMR] had a higher risk of intraprocedural bleeding than cold resection [3% (95% CI 0.01–0.05, I 2 = 68%) vs 0% (95% CI 0–0.01, I 2 = 0%)], while the incidences of delayed bleeding, perforation and post-polypectomy syndrome were all low. Conclusions: Methods with submucosal uplifting effects are more effective than those without for resecting 10- to 20-mm nonpedunculated colorectal polyps, and cold EMR is associated with a lower risk of intraprocedural bleeding than other methods. Additional research is needed to verify the advantages of these methods, especially cold EMR.

show abstract

“…Thanks for these comments and questions. 1 Essentially all of the lesions in our study 2 were removed piecemeal. The lesions in the avulsion arm of our study had a mean size of 30.6 mm.…”

Section: Responsementioning

confidence: 99%

Concerns about the safety and efficacy of hot avulsion as an adjunct to EMR

Wang

Zhao

Wang

2019

Gastrointestinal Endoscopy

View full text Add to dashboard Cite

We read with interest the article by Kumar et al 1 that concluded that hot avulsion is a safe and effective adjunct to EMR when colorectal laterally spreading tumors (LSTs) cannot be resected entirely by a snare technique. We would like to raise several concerns, and we will appreciate the authors' clarification of some details. First, complete en bloc resection of LSTs, especially for lesions >20 mm, is generally difficult by simple EMR; endoscopic piecemeal mucosal resection (EPMR) and endoscopic submucosal dissection (ESD) are often introduced. 2 Tumor recurrence is a great concern during clinical practice. Terasaki et al 2 reported that local recurrence was 0% in ESD, 1.4% in EMR, and 12.1% in EPMR. The 17% recurrence was higher in this report. How many cases were treated by EPMR, either with avulsion or not? The size of subgroup analysis or propensity score matching should be suggested to reduce a statistical bias. Second, fibrosis or resisting snaring might indicate potential invasion or lymphovascular involvement, especially in the nongranular type of LST. 3-5 As claimed, hot avulsion was mostly applied for adenoma. Will histologic differentiation affect the postoperative recurrence? It would be helpful to collect the clinical data including biopsy, preoperative histologic features, endoscopic resection history, and so on. Would it be more reasonable to group patients according to these factors? Third, for EMR with avulsion or not, the postoperative pathologic features were hard to determine, especially the positive surgical margin rates. We hope that the authors could clarify their consideration about the indications for endoscopic intervention and evaluation of margins. Tumor histologic features were not mentioned in this study, which should be critical in a discussion of the potential cause of resisting snaring. 2,4 As a technique, hot avulsion might be a useful adjunctive approach for uncomplete EMR. 6 More studies should be applied to evaluate its safety and efficacy when tumor pathologic features and invasion are considered.

show abstract

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

Cited by 29 publications

References 26 publications

When and How To Use Endoscopic Tattooing in the Colon: An International Delphi Agreement

When and How To Use Endoscopic Tattooing in the Colon: An International Delphi Agreement

Effectiveness and safety of the different endoscopic resection methods for 10- to 20-mm nonpedunculated colorectal polyps: A systematic review and pooled analysis

Concerns about the safety and efficacy of hot avulsion as an adjunct to EMR

Contact Info

Product

Resources

About