European Society of Gastrointestinal Endoscopy (ESGE) guideline: the use of electrosurgical units

Electrosurgery is used in the majority of endoscopic therapeutic procedures. An understanding of the fundamental electrosurgical principles and various settings available on electrosurgical units is essential for the safe and effective use of electrosurgery during endoscopy. The aims of these technical guidelines are to: (1) expose physical principles relevant to the understanding of electrosurgery during endoscopy; (2) describe and provide practical recommendations regarding electrosurgical units that are commonly in use; (3) discuss the clinical relevance of technologies recently implemented in newer electrosurgical units; and (4) review factors relevant to commonly performed therapeutic procedures, including polypectomy, sphincterotomy, contact thermal hemostasis, and argon plasma coagulation.

References

• 1 Cushing H. Electro-surgery as an aid to the removal of intracranial tumors.  Surg Gynecol Obstet. 1928;  47 751-784
• 2 Wright V C. Contemporary electrosurgery: physics for physicians.  J Fam Pract. 1994;  39 119-122
• 3 Curtiss L E. High frequency currents in endoscopy: a review of principles and precautions.  Gastrointest Endosc. 1973;  20 9-12
• 4 Morris M L, Tucker R D, Baron T H, Song L MWK. Electrosurgery in gastrointestinal endoscopy: principles to practice.  Am J Gastroenterol. 2009;  104 1563-1574
• 5 American Society of Anesthesiologists Task Force on Perioperative Management of Patients with Cardiac Rhythm Management Devices . Practice advisory for the perioperative management of patients with cardiac rhythm management devices: pacemakers and implantable cardioverter-defibrillators.  Anesthesiology. 2005;  103 186-198
• 6 Parra-Blanco A, Kaminaga N, Kojima T. et al . Colonoscopic polypectomy with cutting current: is it safe?.  Gastrointest Endosc. 2000;  51 676-681
• 7 Tucker R D, Platz C E, Sievert C E. et al . In vivo evaluation of monopolar versus bipolar electrosurgical polypectomy snares.  Am J Gastroenterol. 1990;  85 1386-1390
• 8 Kim H S, Kim T I, Kim W H. et al . Risk factors for immediate postpolypectomy bleeding of the colon: a multicenter study.  Am J Gastroenterol. 2006;  101 1333-1341
• 9 Van Gossum A, Cozzoli A, Adler M. et al . Colonoscopic snare polypectomy: analysis of 1485 resections comparing two types of current.  Gastrointest Endosc. 1992;  38 472-475
• 10 Fry L C, Lazenby A J, Mikolaenko I. et al . Diagnostic quality of polyps resected by snare polypectomy: does the type of electrosurgical current used matter?.  Am J Gastroenterol. 2006;  101 2123-2127
• 11 Singh N, Harrison M, Rex D K. A survey of colonoscopic polypectomy practices among clinical gastroenterologists.  Gastrointest Endosc. 2004;  60 414-418
• 12 Vanagunas A, Jacob P, Vakil N. Adequacy of ”hot biopsy” for the treatment of diminutive polyps: a prospective randomized trial.  Am J Gastroenterol. 1989;  84 383-385
• 13 Monahan D W, Peluso F E, Goldner F. Combustible colonic gas levels during flexible sigmoidoscopy and colonoscopy.  Gastrointest Endosc. 1992;  38 40-43
• 14 Avgerinos A, Kalantzis N, Rekoumis G. et al . Bowel preparation and the risk of explosion during colonoscopic polypectomy.  Gut. 1984;  25 361-364
• 15 Johlin F C, Tucker R D, Ferguson S. The effect of guidewires during electrosurgical sphincterotomy.  Gastrointest Endosc. 1992;  38 536-540
• 16 Ratani R S, Mills T N, Ainley C C, Swain C P. Electrophysical factors influencing endoscopic sphincterotomy.  Gastrointest Endosc. 1999;  49 43-52
• 17 Verma D, Kapadia A, Adler D G. Pure versus mixed electrosurgical current for endoscopic biliary sphincterotomy: a meta-analysis of adverse outcomes.  Gastrointest Endosc. 2007;  66 283-290
• 18 Norton I D, Petersen B T, Bosco J. et al . A randomized trial of endoscopic biliary sphincterotomy using pure-cut versus combined cut and coagulation waveforms.  Clin Gastroenterol Hepatol. 2005;  3 1029-1033
• 19 Dumonceau J M, Andriulli A, Deviere J. et al . European Society of Gastrointestinal Endoscopy (ESGE) Guideline: prophylaxis of post-ERCP pancreatitis.  Endoscopy. 2010;  42 503-515
• 20 Gorelick A, Cannon M, Barnett J. et al . First cut, then blend: an electrocautery technique affecting bleeding at sphincterotomy.  Endoscopy. 2001;  33 976-980
• 21 Stefanidis G, Karamanolis G, Viazis N. et al . A comparative study of postendoscopic sphincterotomy complications with various types of electrosurgical current in patients with choledocholithiasis.  Gastrointest Endosc. 2003;  57 192-197
• 22 Farin G, Grund K E. Technology of argon plasma coagulation with particular regard to endoscopic applications.  Endosc Surg Allied Technol. 1994;  2 71-77
• 23 Brooker J C, Saunders B P, Shah S G. et al . Treatment with argon plasma coagulation reduces recurrence after piecemeal resection of large sessile colonic polyps: a randomized trial and recommendations.  Gastrointest Endosc. 2002;  55 371-375
• 24 Manner H, Enderle M D, Pech O. et al . Second-generation argon plasma coagulation: two-center experience with 600 patients.  J Gastroenterol Hepatol. 2008;  23 872-878
• 25 Savides T J, See J A, Jensen D M. et al . Randomized controlled study of injury in the canine right colon from simultaneous biopsy and coagulation with different hot biopsy forceps.  Gastrointest Endosc. 1995;  42 573-578
• 26 Saito Y, Uraoka T, Matsuda T. et al . Endoscopic treatment of large superficial colorectal tumors: a case series of 200 endoscopic submucosal dissections (with video).  Gastrointest Endosc. 2007;  66 966-973
• 27 Siegel J H, Veerappan A, Tucker R. Bipolar versus monopolar sphincterotomy: a prospective trial.  Am J Gastroenterol. 1994;  89 1827-1830
• 28 Tucker R D, Sievert C E, Platz C E. et al . Bipolar electrosurgical sphincterotomy.  Gastrointest Endosc. 1992;  38 113-117
• 29 Laine L, McQuaid K R. Endoscopic therapy for bleeding ulcers: an evidence-based approach based on meta-analyses of randomized controlled trials.  Clin Gastroenterol Hepatol. 2009;  7 33-47; quiz 31 – 32