Association between the ulcer status and the risk of delayed bleeding after the endoscopic mucosal resection of colon

2017 ◽  
Vol 32 (11) ◽  
pp. 1846-1851 ◽  
Author(s):  
Gwang-Un Kim ◽  
Myeongsook Seo ◽  
Eun Mi Song ◽  
Sung Wook Hwang ◽  
Sang Hyoung Park ◽  
...  
Keyword(s):  
Endoscopic Mucosal Resection ◽  
Delayed Bleeding ◽  
Mucosal Resection

scholarly journals Clip placement to prevent delayed bleeding after colonic endoscopic mucosal resection (CLIPPER): study protocol for a randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ayla S. Turan ◽  
◽  
Leon M. G. Moons ◽  
Ramon-Michel Schreuder ◽  
Erik J. Schoon ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
The Netherlands ◽  
Endoscopic Mucosal Resection ◽  
Intervention Group ◽  
Proximal Colon ◽  
Control Group ◽  
Colon Polyps ◽  
Delayed Bleeding ◽  
Randomized Controlled ◽  
Mucosal Resection

Abstract Background Endoscopic mucosal resection (EMR) for large colorectal polyps is in most cases the preferred treatment to prevent progression to colorectal carcinoma. The most common complication after EMR is delayed bleeding, occurring in 7% overall and in approximately 10% of polyps ≥ 2 cm in the proximal colon. Previous research has suggested that prophylactic clipping of the mucosal defect after EMR may reduce the incidence of delayed bleeding in polyps with a high bleeding risk. Methods The CLIPPER trial is a multicenter, parallel-group, single blinded, randomized controlled superiority study. A total of 356 patients undergoing EMR for large (≥ 2 cm) non-pedunculated polyps in the proximal colon will be included and randomized to the clip group or the control group. Prophylactic clipping will be performed in the intervention group to close the resection defect after the EMR with a distance of < 1 cm between the clips. Primary outcome is delayed bleeding within 30 days after EMR. Secondary outcomes are recurrent or residual polyps and clip artifacts during surveillance colonoscopy after 6 months, as well as cost-effectiveness of prophylactic clipping and severity of delayed bleeding. Discussion The CLIPPER trial is a pragmatic study performed in the Netherlands and is powered to determine the real-time efficacy and cost-effectiveness of prophylactic clipping after EMR of proximal colon polyps ≥ 2 cm in the Netherlands. This study will also generate new data on the achievability of complete closure and the effects of clip placement on scar surveillance after EMR, in order to further promote the debate on the role of prophylactic clipping in everyday clinical practice. Trial registration ClinicalTrials.gov NCT03309683. Registered on 13 October 2017. Start recruitment: 05 March 2018. Planned completion of recruitment: 31 August 2021.

scholarly journals Anchoring the snare tip is a feasible endoscopic mucosal resection method for small rectal neuroendocrine tumors

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jeongseok Kim ◽  
Jisup Kim ◽  
Eun Hye Oh ◽  
Nam Seok Ham ◽  
Sung Wook Hwang ◽  
...  
Keyword(s):  
Endoscopic Mucosal Resection ◽  
Neuroendocrine Tumors ◽  
Similar Efficacy ◽  
En Bloc Resection ◽  
Lesion Size ◽  
Bloc Resection ◽  
En Bloc ◽  
Delayed Bleeding ◽  
Mucosal Resection ◽  
The Mean

AbstractSmall rectal neuroendocrine tumors (NETs) can be treated using cap-assisted endoscopic mucosal resection (EMR-C), which requires additional effort to apply a dedicated cap and snare. We aimed to evaluate the feasibility of a simpler modified endoscopic mucosal resection (EMR) technique, so-called anchored snare-tip EMR (ASEMR), for the treatment of small rectal NETs, comparing it with EMR-C. We retrospectively evaluated 45 ASEMR and 41 EMR-C procedures attempted on small suspected or established rectal NETs between July 2015 and May 2020. The mean (SD) lesion size was 5.4 (2.2) mm and 5.2 (1.7) mm in the ASEMR and EMR-C groups, respectively (p = 0.558). The en bloc resection rates of suspected or established rectal NETs were 95.6% (43/45) and 100%, respectively (p = 0.271). The rates of histologic complete resection of rectal NETs were 94.1% (32/34) and 88.2% (30/34), respectively (p = 0.673). The mean procedure time was significantly shorter in the ASEMR group than in the EMR-C group (3.12 [1.97] vs. 4.13 [1.59] min, p = 0.024). Delayed bleeding occurred in 6.7% (3/45) and 2.4% (1/41) of patients, respectively (p = 0.618). In conclusion, ASEMR was less time-consuming than EMR-C, and showed similar efficacy and safety profiles. ASEMR is a feasible treatment option for small rectal NETs.

A Management Algorithm Based on Delayed Bleeding After Wide-Field Endoscopic Mucosal Resection of Large Colonic Lesions

2014 ◽  
Vol 12 (9) ◽  
pp. 1525-1533 ◽  
Author(s):  
Nicholas G. Burgess ◽  
Stephen J. Williams ◽  
Luke F. Hourigan ◽  
Gregor J. Brown ◽  
Simon A. Zanati ◽  
...  
Keyword(s):  
Endoscopic Mucosal Resection ◽  
Wide Field ◽  
Delayed Bleeding ◽  
Mucosal Resection ◽  
Management Algorithm

Endoscopic Mucosal Resection of Sporadic Duodenal Adenomas: An Efficient Technique with a High Risk of Delayed Bleeding

2007 ◽  
Vol 65 (5) ◽  
pp. AB271
Author(s):  
Marwan Chemaly ◽  
Vincent Lepilliez ◽  
Jean Christophe Saurin ◽  
Bertrand Napoleon ◽  
Thierry Ponchon
Keyword(s):  
High Risk ◽  
Endoscopic Mucosal Resection ◽  
Efficient Technique ◽  
Delayed Bleeding ◽  
Mucosal Resection ◽  
Duodenal Adenomas

Complication risk despite preventive endoscopic measures in patients undergoing endoscopic mucosal resection of large duodenal adenomas

Endoscopy ◽  
2020 ◽  
Vol 52 (10) ◽  
pp. 847-855
Author(s):  
Andreas Probst ◽  
Simone Freund ◽  
Lukas Neuhaus ◽  
Alanna Ebigbo ◽  
Georg Braun ◽  
...  
Keyword(s):  
Endoscopic Mucosal Resection ◽  
Minor Bleeding ◽  
Delayed Bleeding ◽  
Mucosal Resection ◽  
Duodenal Adenomas ◽  
Major Complications ◽  
Complication Risk ◽  
Substantial Risk ◽  
Bleeding Episodes ◽  
Delayed Complications

Abstract Background Endoscopic mucosal resection (EMR) is the standard treatment of ampullary and nonampullary duodenal adenomas. EMR of large (10–29 mm) and giant (≥ 30 mm) lesions carries a risk of complications such as delayed bleeding and perforation. Prospective data on duodenal EMR are scarce. This study aimed to evaluate the efficacy of endoscopic procedures (clipping and coagulation of visible vessels) to prevent complications after EMR of large and giant lesions. Methods 110 patients with 118 adenomas (29 ampullary and 89 nonampullary) were included prospectively. Results 15 lesions were small (12.7 %), 68 were large (57.6 %), and 35 were giant (29.7 %). Endoscopic prevention of delayed complications was performed in 81.4 % (n = 96) of all lesions and 94.3 % (n = 33) of giant lesions. Complete resection was achieved in 111 lesions (94.1 %). Complications were 22 delayed bleedings (18.6 %), 3 intraprocedural perforations (2.5 %), 2 delayed perforations (1.7 %), and 1 stricture (0.8 %). Major complications were associated with lesions size ≥ 30 mm (28.6 % vs. 9.6 %; P = 0.02) and ampullary adenomas (27.6 % vs. 11.2 %; P = 0.07). All minor bleeding and 75 % of major bleeding episodes were treated endoscopically; 25 % of major bleedings needed radiologic embolization. Two fatal courses were observed when delayed perforation occurred after EMR of giant lesions. Residual adenoma was detected in 20.4 % at first follow-up. Conclusions EMR of giant duodenal neoplasia carries a substantial risk of major complications and recurrences. Resection technique and prevention of delayed complications need to be improved. Further measures should be evaluated in randomized studies.

ID: 3523443 CLINICAL VALIDATION OF ACER, GSSED-RE, GSSED-RE2 SCORES FOR PREDICTION OF DELAYED BLEEDING AFTER ENDOSCOPIC MUCOSAL RESECTION OF LARGE COLORECTAL LESIONS

2021 ◽  
Vol 93 (6) ◽  
pp. AB118-AB119
Author(s):  
Ayesha Kamal ◽  
Venkata S. Akshintala ◽  
Douglas K. Rex ◽  
Yervant Ichkhanian ◽  
Muhammad K. Hasan ◽  
...  
Keyword(s):  
Endoscopic Mucosal Resection ◽  
Clinical Validation ◽  
Delayed Bleeding ◽  
Mucosal Resection

scholarly journals Snare tip soft coagulation (STSC) after endoscopic mucosal resection (EMR) of large (> 20 mm) non pedunculated colorectal polyps: a systematic review and meta-analysis

2022 ◽  
Vol 10 (01) ◽  
pp. E74-E81
Author(s):  
Saurabh Chandan ◽  
Antonio Facciorusso ◽  
Daryl Ramai ◽  
Smit Deliwala ◽  
Babu P. Mohan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Endoscopic Mucosal Resection ◽  
Meta Analysis ◽  
Colorectal Polyps ◽  
Resection Margins ◽  
Effective Technique ◽  
Delayed Bleeding ◽  
Adenoma Recurrence ◽  
Mucosal Resection ◽  
Soft Coagulation

Abstract Background and study aims Endoscopic mucosal resection (EMR) of laterally spreading tumors (LSTs) > 20 mm in size can be challenging. Piecemeal EMR of these lesions results in high rates of adenoma recurrence at first surveillance colonoscopy (SC1). Snare tip soft coagulation (STSC) of post resection margins is a safe and effective technique to prevent adenoma recurrence. We conducted a systematic review and meta-analysis to evaluate the effectiveness and safety of this technique. Patients and methods Multiple databases were searched through April 2021 for studies that reported on outcomes of post EMR STSC for LSTs > 20 mm in size. Meta-analysis was performed to determine pooled odds of adenoma recurrence as well as pooled proportion of adverse events including intraprocedural and delayed bleeding as well as intraprocedural perforation events. Results Six studies including two randomized controlled trials (RCT) and four cohort studies with 2122 patients were included in the final analysis. Overall pooled odds of adenoma recurrence at SC1 with post EMR STSC compared to no STSC was 0.27 (95 % 0.18–0.42; I2 = 0 %), P < 0.001. Pooled rate of adenoma recurrence at SC1 in post EMR STSC cohort was 6 %. Rates of intraprocedural bleeding, delayed bleeding and intraprocedural perforation were 10.3 %, 6.5 % and 2 % respectively. Conclusions Our results show that thermal ablation of resection margins with STSC in LSTs > 20 mm is a safe and effective technique in reducing the incidence of adenoma recurrence.

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