RSS-Feed abonnieren
DOI: 10.1055/s-0035-1569647
Knife-assisted snare resection: a novel technique for resection of scarred polyps in the colon
Publikationsverlauf
submitted30. März 2015
accepted after revision12. November 2015
Publikationsdatum:
28. Januar 2016 (online)
![](https://www.thieme-connect.de/media/endoscopy/201603/lookinside/thumbnails/12347_10-1055-s-0035-1569647-1.jpg)
Background and study aims: There have been significant advances in the management of complex colorectal polyps. Previous failed resection or polyp recurrence is associated with significant fibrosis, making endoscopic resection extremely challenging; the traditional approach to these lesions is surgery. The aim of this study was to evaluate the efficacy of a novel, knife-assisted snare resection (KAR) technique in the resection of scarred colonic polyps.
Patients and methods: This was a prospective cohort study of patients, in whom the KAR technique was used to resect scarred colonic polyps > 2 cm in size. Patients had previously undergone endoscopic mucosal resection (EMR) and developed recurrence, or EMR had been attempted but was aborted as a result of technical difficulty.
Results: A total of 42 patients underwent KAR of large (median 40 mm) scarred polyps. Surgery for benign disease was avoided in 38 of 41 patients (93 %). No life-threatening complications occurred. Recurrence was seen in six patients (16 %), five of whom underwent further endoscopic resection. The overall cure rate for KAR in complex scarred colonic polyps was 90 %.
Conclusions: KAR of scarred colonic polyps by an expert endoscopist was an effective and safe technique with low recurrence rates.
-
References
- 1 Moss A, Williams SJ, Hourigan LF et al. Long-term adenoma recurrence following wide-field endoscopic mucosal resection (WF-EMR) for advanced colonic mucosal neoplasia is infrequent: results and risk factors in 1000 cases from the Australian Colonic EMR (ACE) study. Gut 2015; 64: 57-65
- 2 Friedland S, Banerjee S, Kochar R et al. Outcomes of repeat colonoscopy in patients with polyps referred for surgery without biopsy proven cancer. Gastrointest Endosc 2014; 79: 101-107
- 3 Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 2015; 47: 829-854
- 4 Buchner AM, Guarner-Argente C, Ginsberg GG. Outcomes of EMR of defiant colorectal lesions direct to an endoscopy referral centre. Gastrointest Endosc 2012; 76: 255-263
- 5 Veerappan SG, Ormonde D, Yussoff IF et al. Hot avulsion: a modification of an existing technique for management of nonlifting areas of a polyp (with video). Gastrointest Endosc 2014; 80: 884-888
- 6 Tsiamoulous ZP, Bourikas LA, Saunders BP. Endoscopic mucosal ablation: a new argon plasma coagulation/injection technique to assist complete resection of recurrent, fibrotic colon polyps. Gastrointest Endosc 2012; 75: 400-404
- 7 Voloyiannis T, Snyder MJ, Bailey RR et al. Management of the difficult colon polyp referred for resection: resect or rescope?. Dis Colon Rectum 2008; 51: 292-295
- 8 Birkmeyer JD, Siewers AE, Finlayson EVA et al. Hospital volume and surgical mortality in the United States. NEJM 2002; 346: 1128-1137
- 9 Moss A, Bourke MJ, Williams SJ et al. Endoscopic mucosal resection outcomes and prediction of submucosal cancer from advanced colonic mucosal neoplasia. Gastroenterology 2011; 140: 1909-1918