ROLE OF DOUBLE CHANNEL ENDOSCOPE (DCE) IN ENDOSCOPIC MUCOSAL RESECTION (EMR) COMPARED WITH CONVENTIONAL SINGLE CHANNEL ENDOSCOPE (SCE): EFFECTIVENESS AND SAFETY

Aims:

EMR may present up to 25% complications and 15% recurrences. Polypectomy assisted with DCE has not been studied. Main objetives were determine clinical success and safety of EMR-DCE compared to SCE.

Methods:

53 EMR achieved between 2013 – 2018 with DCE (GIF-180-Olympus). 106 polyps > 15 mm in control-group. Polyps mean size was 27 mm (p < 0.007). 24 variables. EMR-DCE were perform by 2 endoscopists with simultaneous forceps-diathermy loop. Transversal-right colon were the most frequent location in DCE-group where sessile and flat polyps (p < 0.001) with previous biopsies and central depression (p = 0.005) had predominance. Failed Previous Attempts (p < 0.001) were defined when an endoscopist was not able to perform a complex polypectomy or he started it and could not be completed. We defined clinical success as the absence of recurrence in the endoscopic control.

Results:

Serrated polyps (p < 0.011) and in-situ carcinoma (p < 0.001) were resected more in DCE-group. We have completely resected 8 subepithelial lesions with DCE: neuroendocrine tumors (carcinoids = 5), leiomyomas = 2, GIST = 1. All complications were solved during endoscopy.

Tab. 1:

Results

	Double Channel Endoscope (n = 53)	Single Channel Endoscope (n = 106)	aOR (95% CI)	Significance
Clinical success	44 (93.61%)	93 (87.74%)	5.23 (1.27;30.39)	p = 0.037
Total complications/Hemorrhages/Perforations	13 (24.53%)/9 (16.98%)/4 (7.55%)	9 (8.49%)/7 (6.60%)/2 (1.89%)	2.40 (0.87;6.62)/2.59 (0.85;8.12)/1.18 (0.14;10.83)	p = 0.08/p = 0.09/p = 0.87

Conclusions:

EMR-DCE is more effective than EMR-SCE for large and complex polyps and it could be a rescue technique for failed EMR-SCE attempts. This may be due to DCE allows to extend lateral safety margins more easily and to resect fibrin plates of the polyps with central depression with the help of the forceps traction. Also, DCE permits to reach deeper resection planes resecting subepithelial lesions. Although DCE is a short endoscope we believe that its rigidity allows to arrive in the right colon without difficulty. While the rate of complications is higher with DCE due to its complexity, there are no differences in severity compared to EMR-SCE.