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CC BY 4.0 · Endoscopy 2024; 56(12): 978-979
DOI: 10.1055/a-2419-2195
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Prophylactic saline-immersion snare-tip vessel coagulation after colorectal endoscopic resection

Antonio Capogreco
1   Digestive Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy (Ringgold ID: RIN9268)
,
Roberto de Sire
2   Gastroenterology, IBD Unit, Department of Clinical Medicine and Surgery, University Federico II, Napoli, Italy
3   Gastroenterology, Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
,
Davide Massimi
4   Digestive Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy (Ringgold ID: RIN9268)
,
Ludovico Alfarone
5   Digestive Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy (Ringgold ID: RIN9268)
,
Roberta Maselli
6   Digestive Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy (Ringgold ID: RIN9268)
7   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy (Ringgold ID: RIN437807)
,
Cesare Hassan
8   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy (Ringgold ID: RIN437807)
9   Digestive Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy (Ringgold ID: RIN9268)
,
Alessandro Repici
10   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy (Ringgold ID: RIN437807)
11   Digestive Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy (Ringgold ID: RIN9268)
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Endoscopic mucosal resection (EMR) for large colorectal adenomatous lesions is hampered by a relevant risk of post-EMR delayed bleeding [1] [2]. Patients who have proximal lesions and/or are on antithrombotic treatment are at higher risk for such delayed bleeding [3].

Post-EMR prophylactic vessel coagulation has been previously standardized as the application of a low-voltage current using hemostatic forceps [4]. However, this requires a time-consuming device exchange, as well as an additional cost. In addition, the application of a low-voltage current by a relatively large forceps may result in deep thermal injury.

A recent peroral endoscopic myotomy-based series reported that a high-voltage coagulation current delivered through a dedicated knife in a saline-immersion setting maximizes the coagulation effect, preventing unintentional cutting of the vessel wall [5].

We present the case of an 84-year-old woman who underwent an underwater piecemeal EMR (Captivator II, 15 mm; Boston Scientific, Marlborough, Massachusetts, USA) for a large (50 mm) right colon laterally spreading tumor granular-type without endoscopic features of submucosal invasive cancer. To prevent delayed bleeding, prophylactic saline-immersion coagulation was performed at the end of the procedure ([Video 1]).


Quality:
Prophylactic saline-immersion coagulation for prevention of delayed bleeding after endoscopic mucosal resection for right colonic laterally spreading tumor.Video 1

The snare tip was gently placed in contact with the visible vessels and a high-voltage coagulation current (ForcedCOAG E4.0, ERBE VIO3; ERBE Elektromedizin GmbH, Tübingen, Germany) was delivered. This resulted in progressive presealing of the vessels without any cutting effect ([Fig. 1]). The patient was discharged 4 hours after the procedure with no relevant post-procedural symptoms. No delayed bleeding or other adverse events were reported up to 30 days after the procedure.

Zoom Image
Fig. 1 Endoscopic images of saline-immersion coagulation. a Blood vessel identification (dashed line) after endoscopic mucosal resection. b Prophylactic snare-tip coagulation. c The vessels appear whitish after application of the high-current voltage under saline immersion. d Resection bed after saline-immersion snare-tip vessel coagulation.

This novel technique aims to reduce the risk of delayed bleeding after endoscopic resection using a one-device, cost-effective, and time-sparing approach. It also highlights the potential applications of saline-immersion coagulation in the field of endoscopy, which appear to be universal and irrespective of the technique, device, or type of current adopted.

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Publication History

Article published online:
28 November 2024

© 2024. The Author(s). This article was originally published by Thieme in Endoscopy 2024; 56: E622–E623 as an open access article under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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  • References

  • 1 Ferlitsch M, Moss A, Hassan C. et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2017; 49: 270-297
    Thieme ConnectPubMedSearch in Google Scholar
  • 2 Albéniz E, Montori S, Rodríguez De Santiago E. et al. Preventing postendoscopic mucosal resection bleeding of large nonpedunculated colorectal lesions. Am J Gastroenterol 2022; 117: 1080-1088
    CrossrefPubMedSearch in Google Scholar
  • 3 Spadaccini M, Albéniz E, Pohl H. et al. Prophylactic clipping after colorectal endoscopic resection prevents bleeding of large, proximal polyps: meta-analysis of randomized trials. Gastroenterology 2020; 159: 148-158
    CrossrefPubMedSearch in Google Scholar
  • 4 Bahin FF, Naidoo M, Williams SJ. et al. Prophylactic endoscopic coagulation to prevent bleeding after wide-field endoscopic mucosal resection of large sessile colon polyps. Clin Gastroenterol Hepatology 2015; 13: 724-730
    CrossrefPubMedSearch in Google Scholar
  • 5 Capogreco A, Hassan C, De Blasio F. et al. Prophylactic underwater vessel coagulation for submucosal endoscopy. Gut 2024; 73: 1049-1051
    CrossrefPubMedSearch in Google Scholar