scholarly journals Efficacy and safety of cap-assisted endoscopic mucosal resection of ileocecal valve polyps

2020 ◽  
Vol 08 (03) ◽  
pp. E241-E246
Author(s):  
Daniel Lew ◽  
Amir Kashani ◽  
Simon K. Lo ◽  
Laith H. Jamil
Keyword(s):  
Endoscopic Mucosal Resection ◽  
Care Center ◽  
Tertiary Care ◽  
Ileocecal Valve ◽  
Efficacy And Safety ◽  
Polyp Size ◽  
En Bloc ◽  
Negative Biopsy ◽  
Mucosal Resection

Abstract Background and study aims Standard endoscopic mucosal resection (EMR) of ileocecal valve (ICV) polyps is challenging. Cap-assisted endoscopic mucosal resection (C-EMR) can be performed when polyps are not easily amenable to standard EMR. Current literature is limited regarding its efficacy and safety for ICV polyps. The objectives of this study were to assess the efficacy and safety of C-EMR for ICV polyps. Patients and methods A retrospective review was conducted from September 2008 to November 2018 at a tertiary care center. Patients included in the study underwent C-EMR for ICV polyps by a single gastroenterologist (LHJ). Polyps were successfully eradicated if they were removed en-bloc as confirmed by pathology, or had a negative biopsy on follow-up colonoscopy. Outcomes of the procedures were evaluated, including complete adenoma clearance and adverse events. Results Twenty-one ICV polyps were removed with C-EMR. Median polyp size was 15 mm (range, 5–45). The rate of complete adenoma clearance was 100 %. Procedure-related complications occurred in five patients (24 %): delayed GI bleeding (4.8 %) and deep mucosal resection/visible vessel (14.3 %). Three patients had subsequent surveillance colonoscopies at 8, 56, and 67 months, respectively. The third patient was found to have a 6-mm flat polyp at the edge of the previous polypectomy site. This was treated with C-EMR and repeat colonoscopy 6 months later did not show residual. Conclusion C-EMR is highly effective in treating ICV polyps with a low complication rate. It is our suggested method in approaching ICV polyps that are difficult to remove via standard freehand snare EMR technique.

Su1496 Esophageal Endoscopic Mucosal Resection: Efficacy and Safety At a Tertiary Care Center

2013 ◽  
Vol 77 (5) ◽  
pp. AB346
Author(s):  
Sarina Pasricha ◽  
Kelly E. Hathorn ◽  
William J. Bulsiewicz ◽  
Nan Li ◽  
Albert J. Rogers ◽  
...  
Keyword(s):  
Endoscopic Mucosal Resection ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Efficacy And Safety ◽  
Mucosal Resection

scholarly journals Endoscopic resection outcomes and predictors of failed en bloc endoscopic mucosal resection of colorectal polyps ≤ 20 mm among advanced endoscopy trainees

2021 ◽  
Vol 09 (11) ◽  
pp. E1820-E1826
Author(s):  
William W. King ◽  
Peter V. Draganov ◽  
Andrew Y. Wang ◽  
Dushant Uppal ◽  
Amir Rumman ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Endoscopic Mucosal Resection ◽  
En Bloc Resection ◽  
Lesion Size ◽  
Bloc Resection ◽  
Colorectal Polyps ◽  
Polyp Size ◽  
En Bloc ◽  
Mucosal Resection ◽  
Piecemeal Resection

Abstract Background and study aims En bloc endoscopic mucosal resection (EMR) is preferred over piecemeal resection for polyps ≤ 20 mm. Data on colorectal EMR training are limited. We aimed to evaluate the en bloc EMR rate of polyps ≤ 20 mm among advanced endoscopy trainees and to identify predictors of failed en bloc EMR. Methods This was a multicenter prospective study evaluating trainee performance in EMR during advanced endoscopy fellowship. A logistic regression model was used to identify the number of procedures and lesion cut-off size associated with an en bloc EMR rate of ≥ 80 %. Multivariate analysis was performed to identify predictors of failed en bloc EMR. Results Six trainees from six centers performed 189 colorectal EMRs, of which 104 (55 %) were for polyps ≤ 20 mm. Of these, 57.7 % (60/104) were resected en bloc. Trainees with ≥ 30 EMRs (OR 6.80; 95 % CI: 2.80–16.50; P = 0.00001) and lesions ≤ 17 mm (OR 4.56;95 CI:1.23–16.88; P = 0.02) were more likely to be associated with an en bloc EMR rate of ≥ 80 %. Independent predictors of failed en bloc EMR on multivariate analysis included: larger polyp size (OR:6.83;95 % CI:2.55–18.4; P = 0.0001), right colon location (OR:7.15; 95 % CI:1.31–38.9; P = 0.02), increased procedural difficulty (OR 2.99; 95 % CI:1.13–7.91; P = 0.03), and having performed < 30 EMRs (OR: 4.87; 95 %CI: 1.05–22.61; P = 0.04). Conclusions In this pilot study, we demonstrated that a relatively low proportion of trainees achieved en bloc EMR for polyps ≤ 20 mm and identified procedure volume and lesion size thresholds for successful en bloc EMR and independent predictors for failed en bloc resection. These preliminary results support the need for future efforts to define EMR procedure competence thresholds during training.

scholarly journals Underwater versus conventional endoscopic mucosal resection for small size non-pedunculated colorectal polyps: a randomized controlled trial

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Zhixin Zhang ◽  
Yonghong Xia ◽  
Hongyao Cui ◽  
Xin Yuan ◽  
Chunnian Wang ◽  
...  
Keyword(s):  
Endoscopic Mucosal Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Colorectal Polyps ◽  
Efficacy And Safety ◽  
Resection Rate ◽  
En Bloc ◽  
Randomized Controlled ◽  
Mucosal Resection ◽  
Group 1

Abstract Background Underwater endoscopic mucosal resection (UEMR) is a recently developed technique and can be performed during water-aided or ordinary colonoscopy for the treatment of colorectal polyps. The objective of this clinical trial was to evaluate the efficacy and safety of UEMR in comparison with conventional endoscopic mucosal resection (CEMR) of small non-pedunculated colorectal polyps. Methods Patients with small size, non-pedunculated colorectal polyps (4–9 mm in size) who underwent colonoscopic polypectomy were enrolled in this multicenter randomized controlled clinical trial. The patients were randomly allocated to two groups, an UEMR group and a CEMR group. Efficacy and safety were compared between groups. Results In the intention-to-treat (ITT) analysis, the complete resection rate was 83.1% (59/71) in the UEMR group and 87.3% (62/71) in the CEMR group. The en-bloc resection rate was 94.4% (67/71) in the UEMR group and 91.5% (65/71) in the CEMR group (difference 2.9%; 90% CI − 4.2 to 9.9%), showed noninferiority (noninferiority margin − 5.7% < − 4.2%). No significant difference in procedure time (81 s vs. 72 s, P = 0.183) was observed. Early bleeding was observed in 1.4% of patients in the CEMR group (1/71) and 1.4% of patients in the UEMR group (1/71). None of the patients in the UEMR group complained of postprocedural bloody stool, whereas two patients in the CEMR group (2/64) reported this adverse event. Conclusion Our results indicate that UEMR is safer and just as effective as CEMR in En-bloc resection for the treatment of small colorectal polyps as such, UEMR is recommended as an alternative approach to excising small and non-pedunculated colorectal adenomatous polyps. Trial registration Clinical Trials.gov, NCT03833492. Retrospectively registered on February 7, 2019.

scholarly journals Underwater endoscopic colorectal polyp resection: Feasibility in everyday clinical practice

2017 ◽  
Vol 6 (3) ◽  
pp. 454-462 ◽  
Author(s):  
Sergio Cadoni ◽  
Mauro Liggi ◽  
Paolo Gallittu ◽  
Donatella Mura ◽  
Lorenzo Fuccio ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Endoscopic Mucosal Resection ◽  
Tertiary Care ◽  
Colorectal Polyp ◽  
Routine Clinical Practice ◽  
Colon Polyps ◽  
En Bloc ◽  
Mucosal Resection ◽  
Small Series ◽  
Immediate Bleeding

Background Endoscopic mucosal resection is well-established for resecting flat or sessile benign colon polyps. The novel underwater endoscopic mucosal resection eschews submucosal injection prior to endoscopic mucosal resection. Reports about underwater endoscopic mucosal resection were limited to small series of single and/or tertiary-care referral centers, with single or supervised operators. Objective The purpose of this study was to determine feasibility and efficacy of underwater resection of polyps of any morphology (underwater polypectomy, here includes underwater endoscopic mucosal resection) in routine clinical practice. Methods This study involved a comparison of colonoscopy records of two community hospitals (January 2015–December 2016) for underwater polypectomy ( n = 195) and gas insufflation polypectomy ( n = 186). Results Comparable demographics, procedural data, overall distribution, morphology and size of resected lesions, number of en bloc and R0 resections (any polyp morphology and size); exception: overall, underwater polypectomy pedunculated polyps were significantly larger than those in the gas insufflation polypectomy group, p = 0.030. Underwater polypectomy (median, min) resection time was significantly shorter than gas insufflation polypectomy: sessile and flat polyps 6–9 mm, 0.8 vs 2.7 ( p = 0.040); 10–19 mm, 2.0 vs 3.3 ( p = 0.025), respectively; pedunculated polyps 6–19 mm, 0.8 vs 3.3 ( p < 0.001). Underwater polypectomy resection of pedunculated polyps 6–19 mm showed significantly less immediate bleeding: 11.1% vs 1.5%, respectively ( p = 0.031). Conclusions Underwater polypectomy can be efficaciously used in routine clinical practice for the complete resection of colon polyps, with several advantages over gas insufflation polypectomy.

scholarly journals Endoscopic mucosal resection of flat and sessile colorectal adenomas: Our experience with long-term follow-ups

2014 ◽  
Vol 71 (1) ◽  
pp. 33-38 ◽  
Author(s):  
Sasa Grgov ◽  
Predrag Dugalic ◽  
Ratko Tomasevic ◽  
Tomislav Tasic
Keyword(s):  
Endoscopic Mucosal Resection ◽  
Complete Removal ◽  
Colorectal Adenomas ◽  
Invasive Technique ◽  
En Bloc ◽  
Carcinoma Of The Colon ◽  
Mucosal Resection ◽  
Piecemeal Resection

Bacground/Aim. Endoscopic mucosal resection (EMR) or mucosectomy is a removing method of flat or sessile lesions, laterally spreading tumors and carcinoma of the colon or the rectum limited to mucosa or the surface part of the submucosa. The aim of the study was to estimate the efficacy and safety of EMR in removing flat and sessile colorectal adenomas. Methods. This prospective study involved 140 patients during the period of 8 years. A total of 187 colorectal adenomas were removed using the EMR method ?inject and cut with snare?. Results. The approximate size of mucosectomised adenomas was 13.6 mm (from 8 mm to 60 mm). There was a total of 48 (25.7%) flat adenomas and 139 (74.3%) sessile adenomas, (p < 0.01). Using ?en bloc? and ?piecemeal? resection, 173 (92.5%) and 14 (7.5%) of colorectal adenomas were removed, respectively. In all the cases, a complete removal of colorectal adenomas was achieved. Two (1.4%) patients had adenoma removal with intramucosal carcinoma each. In the average follow-up period of 21.2 ? 17.8 months, 2 (1.4%) patients had adenoma relapse after EMR. Considering complications, there was bleeding in 1 (0.7%) patient with a big rectum adenoma removed with EMR. Furthermore, one (0.7%) patient had a postcoagulation syndrome after cecal adenoma was removed by EMR. Conclusion. EMR is an efficient, safe and minimally invasive technique of removing flat and sessile adenomas in the colon and the rectum, with a very low percentage of adenoma recurrence over a long period of monitoring.

The efficacy and safety of underwater endoscopic mucosal resection for ≥10-mm colorectal polyps: systematic review and meta-analysis

Endoscopy ◽  
2020 ◽  
Author(s):  
De-feng Li ◽  
Ming-Guang Lai ◽  
Mei-feng Yang ◽  
Zhi-yuan Zou ◽  
Jing Xu ◽  
...  
Keyword(s):  
Endoscopic Mucosal Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Colorectal Polyps ◽  
Complete Resection ◽  
R0 Resection ◽  
Efficacy And Safety ◽  
Resection Rate ◽  
En Bloc ◽  
Mucosal Resection

Abstract Background Underwater endoscopic mucosal resection (UEMR) is a promising strategy for nonpedunculated colorectal polyp removal. However, the efficacy and safety of the technique for the treatment of ≥ 10-mm colorectal polyps remain unclear. We aimed to comprehensively assess the efficacy and safety of UEMR for polyps sized 10–19 mm and ≥ 20 mm. Methods PubMed, EMBASE, and the Cochrane Library databases were searched for relevant articles from January 2012 to November 2019. Primary outcomes were the rates of adverse events and residual polyps. Secondary outcomes were the complete resection, en bloc resection, and R0 resection rates. Results 18 articles including 1142 polyps from 1093 patients met our inclusion criteria. The overall adverse event and residual polyp rates were slightly lower for UEMR when removing colorectal polyps of 10–19 mm vs. ≥ 20 mm (3.5 % vs. 4.3 % and 1.2 % vs. 2.6 %, respectively). The UEMR-related complete resection rate was slightly higher for colorectal polyps of 10–19 mm vs. ≥ 20 mm (97.9 % vs. 92.0 %). However, the en bloc and R0 resection rates were dramatically higher for UEMR removal of polyps of 10–19 mm vs. ≥ 20 mm (83.4 % vs. 36.1 % and 73.0 % vs. 40.0 %, respectively). In addition, univariate meta-regression revealed that polyp size was an independent predictor for complete resection rate (P = 0.03) and en bloc resection (P = 0.01). Conclusions UEMR was an effective and safe technique for the removal of ≥ 10-mm nonpedunculated colorectal polyps. However, UEMR exhibited low en bloc and R0 resection rates for the treatment of ≥ 20-mm polyps.

scholarly journals Overutilization of surgical resection for benign colorectal polyps: analysis from a tertiary care center

2021 ◽  
Vol 09 (05) ◽  
pp. E706-E712
Author(s):  
Rayan Saade ◽  
Tyler Tsang ◽  
Michel Kmeid ◽  
David Miller ◽  
Zhiyan Fu ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Care Center ◽  
Tertiary Care ◽  
Colorectal Polyps ◽  
Left Colon ◽  
Endoscopic Polypectomy ◽  
Polyp Size ◽  
Colorectal Cancer Prevention ◽  
The Right

Abstract Background and study aims Adequate removal of precancerous polyps is an independent factor in colorectal cancer prevention. Despite advances in polypectomy techniques, there is an increasing rate of surgery for benign polyps. We assessed whether surgical resection is properly utilized for benign colorectal polyps. Patients and methods We identified 144 patients with surgical resection for benign colorectal polyps. Polyp location, size and the indication for and type of surgery were obtained. For the purposes of this analysis, we assumed that gastroenterologists should assess polyp size accurately, endoscopically resect polyps < 2 cm, and treat incompletely excised polyps on follow-up. Results A total of 118 patients (82 %) were referred to surgery without attempted endoscopic removal. In 26 (22 %) of 118, the macroscopic polyp size was < 2 cm (23 in right, 3 in the left colon) and 18 (15 %; 14 in the right, four in the left colon) were found to have had size overestimation during endoscopy. Twenty-two (15 %) of 144 underwent surgical resection for incomplete endoscopic resection of adenomas (16 in the right, 6 in the left colon); 12 (54.5 %) had a residual polyp size of < 2 cm (10 in the right colon; 2 in the left colon). In-hospital mortality was 0.7 % and morbidity was 20.1 %. Conclusions Of the patients, 41 % could have potentially avoided surgical intervention (37 polyps < 2 cm and/or size overestimations precluding endoscopic polypectomy and 22 incomplete resections). When including polyps with size ≥ 2 to < 4 cm, the percentage of patients with avoidable surgery reached 80 %. This confirms the need to develop standardized quality metrics for endoscopic polypectomies and for better overall training of endoscopists performing these procedures. Given the risks of surgery, referral to an experienced gastroenterologist should be considered as a first step.

Endoscopic submucosal dissection vs. endoscopic mucosal resection for early Barrett's neoplasia in the West: a retrospective study

Endoscopy ◽  
2021 ◽  
Author(s):  
Lady Katherine Mejia Perez ◽  
Dennis Yang ◽  
Peter V. Draganov ◽  
Salmaan Jawaid ◽  
Amitabh Chak ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Endoscopic Mucosal Resection ◽  
Residual Disease ◽  
Disease Free Survival ◽  
Definitive Treatment ◽  
Event Analysis ◽  
En Bloc ◽  
Mucosal Resection ◽  
Submucosal Dissection

Abstract Background The difference in clinical outcomes after endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) for early Barrett's esophagus (BE) neoplasia remains unclear. We compared the recurrence/residual tissue rates, resection outcomes, and adverse events after ESD and EMR for early BE neoplasia. Methods We included patients who underwent EMR or ESD for BE-associated high grade dysplasia (HGD) or T1a esophageal adenocarcinoma (EAC) at eight academic hospitals. We compared demographic, procedural, and histologic characteristics, and follow-up data. A time-to-event analysis was performed to evaluate recurrence/residual disease and a Kaplan–Meier curve was used to compare the groups. Results 243 patients (150 EMR; 93 ESD) were included. EMR had lower en bloc (43 % vs. 89 %; P < 0.001) and R0 (56 % vs. 73 %; P = 0.01) rates than ESD. There was no difference in the rates of perforation (0.7 % vs. 0; P > 0.99), early bleeding (0.7 % vs. 1 %; P > 0.99), delayed bleeding (3.3 % vs. 2.1 %; P = 0.71), and stricture (10 % vs. 16 %; P = 0.16) between EMR and ESD. Patients with non-curative resections who underwent further therapy were excluded from the recurrence analysis. Recurrent/residual disease was 31.4 % [44/140] for EMR and 3.5 % [3/85] for ESD during a median (interquartile range) follow-up of 15.5 (6.75–30) and 8 (2–18) months, respectively. Recurrence-/residual disease-free survival was significantly higher in the ESD group. More patients required additional endoscopic resection procedures to treat recurrent/residual disease after EMR (EMR 24.2 % vs. ESD 3.5 %; P < 0.001). Conclusions ESD is safe and results in more definitive treatment of early BE neoplasia, with significantly lower recurrence/residual disease rates and less need for repeat endoscopic treatments than with EMR.

scholarly journals S185 Soft Tip Coagulation and Partial Defect Closure in Endoscopic Mucosal Resection: A Tertiary Care Center Experience

2021 ◽  
Vol 116 (1) ◽  
pp. S83-S83
Author(s):  
Mira Alsheikh ◽  
Jean Chalhoub ◽  
Hassan Al Moussawi ◽  
Youssef Eldouaihy ◽  
Harika Kandlakunta ◽  
...  
Keyword(s):  
Endoscopic Mucosal Resection ◽  
Care Center ◽  
Tertiary Care ◽  
Defect Closure ◽  
Tertiary Care Center ◽  
Mucosal Resection
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