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Expanding the field of cold snare polypectomy.

Desomer L, Bourke MJ - Endosc Int Open (2015)

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia.

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Endoscopic mucosal resection (EMR) is now a widely accepted and well described technique for the removal of large laterally spreading lesions (LSL) in both the colon and duodenum... After submucosal injection with a variety of dye-containing solutions, the lesion is removed by sequential snare resections with diathermy... High-volume, prospective multicenter data show that most LSL in the colon can safely and effectively be treated by EMR... However, CSPEB remains a major issue occurring with a frequency of 6 % overall after EMR of LSL in the colon and up to 12 % in the right colon... An effective method of preventing this has yet to be found; therefore, it seems acceptable to explore the field of cold snare polypectomy (CSP) for the removal of large LSL to minimize the risk of delayed bleeding... Furthermore, transection of the muscular propria using a cold snare is probably impossible and so, the risk of perforation is also reduced with CSP... A well-formed cushion after submucosal injection, applied in the majority of the duodenal lesions, elevates the mucosa away from the larger submucosal vessels where most of the bleeding risk is believed to arise... A recent study by Horiuchi et al. has shown the superiority of a thin wire snare dedicated for CSP over a conventional snare for the complete removal of colorectal polyps... Because there is no information on recurrence in this study, we might expect recurrence rates to be lower for polyps removed by a stiff, thin wire snare... Further study is necessary to confirm this... In conclusion, the field of CSP is increasingly being explored, because of its ease of use and low rate of complications... This pilot study has shown an acceptable safety profile but bleeding remains the most important complication and has not been eliminated using the cold snare technique.

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 Post-EMR defect site showing the rich duodenal vascularisation.
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FI353-1:  Post-EMR defect site showing the rich duodenal vascularisation.

Mentions: CSP has proven to be a safe and effective technique for removal of diminutive polyps in the colon 8. However, duodenal polyps represent a completely different group due to the physiologic and anatomic differences as compared to the colon. The thin muscular layer of the duodenal wall in combination with the rich vascularisation makes the duodenum particularly prone to these complications (Fig. 1).


Expanding the field of cold snare polypectomy.

Desomer L, Bourke MJ - Endosc Int Open (2015)

 Post-EMR defect site showing the rich duodenal vascularisation.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4612227&req=5

FI353-1:  Post-EMR defect site showing the rich duodenal vascularisation.
Mentions: CSP has proven to be a safe and effective technique for removal of diminutive polyps in the colon 8. However, duodenal polyps represent a completely different group due to the physiologic and anatomic differences as compared to the colon. The thin muscular layer of the duodenal wall in combination with the rich vascularisation makes the duodenum particularly prone to these complications (Fig. 1).

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Endoscopic mucosal resection (EMR) is now a widely accepted and well described technique for the removal of large laterally spreading lesions (LSL) in both the colon and duodenum... After submucosal injection with a variety of dye-containing solutions, the lesion is removed by sequential snare resections with diathermy... High-volume, prospective multicenter data show that most LSL in the colon can safely and effectively be treated by EMR... However, CSPEB remains a major issue occurring with a frequency of 6 % overall after EMR of LSL in the colon and up to 12 % in the right colon... An effective method of preventing this has yet to be found; therefore, it seems acceptable to explore the field of cold snare polypectomy (CSP) for the removal of large LSL to minimize the risk of delayed bleeding... Furthermore, transection of the muscular propria using a cold snare is probably impossible and so, the risk of perforation is also reduced with CSP... A well-formed cushion after submucosal injection, applied in the majority of the duodenal lesions, elevates the mucosa away from the larger submucosal vessels where most of the bleeding risk is believed to arise... A recent study by Horiuchi et al. has shown the superiority of a thin wire snare dedicated for CSP over a conventional snare for the complete removal of colorectal polyps... Because there is no information on recurrence in this study, we might expect recurrence rates to be lower for polyps removed by a stiff, thin wire snare... Further study is necessary to confirm this... In conclusion, the field of CSP is increasingly being explored, because of its ease of use and low rate of complications... This pilot study has shown an acceptable safety profile but bleeding remains the most important complication and has not been eliminated using the cold snare technique.

No MeSH data available.


Related in: MedlinePlus