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Simple and reliable treatment for post-EMR artificial ulcer floor with snare cauterization for 10- to 20-mm colorectal polyps: a randomized prospective study (with video).

Mori H, Kobara H, Nishiyama N, Fujihara S, Matsunaga T, Ayaki M, Chiyo T, Masaki T - Surg Endosc (2014)

Bottom Line: The time required for wound surface treatment completion was 3.26 ± 1.57 min in the snare cauterization group and 12.7 ± 2.92 min in the clip closure group, thus demonstrating a significant difference (P = 0.0001).The clip group required the use of 720 clips that cost \523,410, US $5,163.50, or <euro>3,665.5.After EMR of with 10- to 20-mm colorectal polyps, snare cauterization was superior to clip closure in terms of procedure time, and medical costs, and not inferior to clip closure in terms of the preventing effect of delayed bleeding.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Kita-gun, Miki-cho, Kagawa, 761-0793, Japan, hiro4884@med.kagawa-u.ac.jp.

ABSTRACT

Background: Comparative studies on wound surface treatments after endoscopic mucosal resection (EMR) of 10- to 20-mm colorectal polyps have not been reported. We conducted a prospective trial of postoperative hemorrhage prevention measures after EMR of such polyps.

Methods: Of 138 patients (397 polyps) who had undergone EMR, 62 patients (148 polyps) with 10- to 20-mm colorectal polyps were enrolled. Using the sealed envelope method, the subjects were randomly assigned to either a snare cauterization (75 polyps) or clip closure group (73 polyps). The primary assessment item was the wound surface treatment time (from immediately after polyp resection to wound surface treatment completion). The secondary assessment items were the incidence of delayed bleeding, perforation incidence 1-7 days after EMR, and difference in medical costs between the groups (University Hospital Medical Information Network: No. 000013473).

Results: The time required for wound surface treatment completion was 3.26 ± 1.57 min in the snare cauterization group and 12.7 ± 2.92 min in the clip closure group, thus demonstrating a significant difference (P = 0.0001). Delayed bleeding was observed in two patients in the clip group, but was not observed in the snare cauterization group (P = 0.098). The clip group required the use of 720 clips that cost \523,410, US $5,163.50, or 3,665.5.

Conclusions: After EMR of with 10- to 20-mm colorectal polyps, snare cauterization was superior to clip closure in terms of procedure time, and medical costs, and not inferior to clip closure in terms of the preventing effect of delayed bleeding.

No MeSH data available.


Related in: MedlinePlus

Snare cauterization procedure (Case 17). A A 14-mm-diameter polyp in the ascending colon. B In preparation for cauterization, sufficient saline was locally injected to create a protrusion >10 mm from the muscle layer. C Following snare resection, the snare tip was lightly pressed against the cut surface, and performed cauterization just above the muscle layer line. D We observed no blood vessels in the cauterized ulcer floor
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Fig2: Snare cauterization procedure (Case 17). A A 14-mm-diameter polyp in the ascending colon. B In preparation for cauterization, sufficient saline was locally injected to create a protrusion >10 mm from the muscle layer. C Following snare resection, the snare tip was lightly pressed against the cut surface, and performed cauterization just above the muscle layer line. D We observed no blood vessels in the cauterized ulcer floor

Mentions: We show one case of snare cauterization group for example. A polyp 14 mm in diameter was observed in the ascending colon (Fig. 2A). After this, sufficient saline was locally injected to create a protrusion >10 mm from the muscle layer (Fig. 2B). Subsequently, snare resection was performed, after which the snare tip was protruded by 2–3 mm only. Then, after sufficiently confirming the cut surface, we cauterized the surface starting from the mucous membrane at the edge (Fig. 2C). Using a tip hood, the stump was sufficiently observed from the front. If the presence of blood vessels was confirmed, the snare tip was lightly pressed horizontally approximately 20° against the cut surface. The surface was then cauterized while estimating the distance of the protrusion to the muscle layer line (Fig. 2D). The region was uniformly cauterized (video 1). Detailed observation revealed a sufficient saline protrusion remaining (Fig. 2C), and no blood vessels were observed in the cauterized ulcer floor (Fig. 2D).Fig. 2


Simple and reliable treatment for post-EMR artificial ulcer floor with snare cauterization for 10- to 20-mm colorectal polyps: a randomized prospective study (with video).

Mori H, Kobara H, Nishiyama N, Fujihara S, Matsunaga T, Ayaki M, Chiyo T, Masaki T - Surg Endosc (2014)

Snare cauterization procedure (Case 17). A A 14-mm-diameter polyp in the ascending colon. B In preparation for cauterization, sufficient saline was locally injected to create a protrusion >10 mm from the muscle layer. C Following snare resection, the snare tip was lightly pressed against the cut surface, and performed cauterization just above the muscle layer line. D We observed no blood vessels in the cauterized ulcer floor
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4541705&req=5

Fig2: Snare cauterization procedure (Case 17). A A 14-mm-diameter polyp in the ascending colon. B In preparation for cauterization, sufficient saline was locally injected to create a protrusion >10 mm from the muscle layer. C Following snare resection, the snare tip was lightly pressed against the cut surface, and performed cauterization just above the muscle layer line. D We observed no blood vessels in the cauterized ulcer floor
Mentions: We show one case of snare cauterization group for example. A polyp 14 mm in diameter was observed in the ascending colon (Fig. 2A). After this, sufficient saline was locally injected to create a protrusion >10 mm from the muscle layer (Fig. 2B). Subsequently, snare resection was performed, after which the snare tip was protruded by 2–3 mm only. Then, after sufficiently confirming the cut surface, we cauterized the surface starting from the mucous membrane at the edge (Fig. 2C). Using a tip hood, the stump was sufficiently observed from the front. If the presence of blood vessels was confirmed, the snare tip was lightly pressed horizontally approximately 20° against the cut surface. The surface was then cauterized while estimating the distance of the protrusion to the muscle layer line (Fig. 2D). The region was uniformly cauterized (video 1). Detailed observation revealed a sufficient saline protrusion remaining (Fig. 2C), and no blood vessels were observed in the cauterized ulcer floor (Fig. 2D).Fig. 2

Bottom Line: The time required for wound surface treatment completion was 3.26 ± 1.57 min in the snare cauterization group and 12.7 ± 2.92 min in the clip closure group, thus demonstrating a significant difference (P = 0.0001).The clip group required the use of 720 clips that cost \523,410, US $5,163.50, or <euro>3,665.5.After EMR of with 10- to 20-mm colorectal polyps, snare cauterization was superior to clip closure in terms of procedure time, and medical costs, and not inferior to clip closure in terms of the preventing effect of delayed bleeding.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Kita-gun, Miki-cho, Kagawa, 761-0793, Japan, hiro4884@med.kagawa-u.ac.jp.

ABSTRACT

Background: Comparative studies on wound surface treatments after endoscopic mucosal resection (EMR) of 10- to 20-mm colorectal polyps have not been reported. We conducted a prospective trial of postoperative hemorrhage prevention measures after EMR of such polyps.

Methods: Of 138 patients (397 polyps) who had undergone EMR, 62 patients (148 polyps) with 10- to 20-mm colorectal polyps were enrolled. Using the sealed envelope method, the subjects were randomly assigned to either a snare cauterization (75 polyps) or clip closure group (73 polyps). The primary assessment item was the wound surface treatment time (from immediately after polyp resection to wound surface treatment completion). The secondary assessment items were the incidence of delayed bleeding, perforation incidence 1-7 days after EMR, and difference in medical costs between the groups (University Hospital Medical Information Network: No. 000013473).

Results: The time required for wound surface treatment completion was 3.26 ± 1.57 min in the snare cauterization group and 12.7 ± 2.92 min in the clip closure group, thus demonstrating a significant difference (P = 0.0001). Delayed bleeding was observed in two patients in the clip group, but was not observed in the snare cauterization group (P = 0.098). The clip group required the use of 720 clips that cost \523,410, US $5,163.50, or 3,665.5.

Conclusions: After EMR of with 10- to 20-mm colorectal polyps, snare cauterization was superior to clip closure in terms of procedure time, and medical costs, and not inferior to clip closure in terms of the preventing effect of delayed bleeding.

No MeSH data available.


Related in: MedlinePlus