Effects of Blended (Yellow) vs Forced Coagulation (Blue) Currents on Adverse Events, Complete Resection, or Polyp Recurrence After Polypectomy in a Large Randomized Trial

Pohl, Heiko; Grimm, Ian S.; Moyer, Matthew T.; Hasan, Muhammad; Pleskow, Douglas K.; Elmunzer, B. Joseph; Khashab, Mouen A.; Al‐Kawas, Firas H.; Gordon, Stuart R.; Mathew, Abraham; Levenick, John M.; Aslanian, Harry R.; Antaki, Fadi; Renteln, Daniel von; Crockett, Seth D.; Rastogi, Amit; Gill, Jeffrey; Law, Ryan; Elias, Puja S.; Pellisé, María; MacKenzie, Todd A.; Rex, Douglas K.

doi:10.1053/j.gastro.2020.03.014

Cited by 40 publications

(27 citation statements)

References 22 publications

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“…Not many studies have compared different types of modes. This study by Pohl et al 3 in this issue of Gastroenterology is important as it demonstrates that there is no substantial difference in safety and efficacy of polypectomy using either blended current or coagulation current. However, the debate over which current mode is best is likely to continue.…”

mentioning

confidence: 88%

“…Some studies have suggested that polypectomy with a coagulation current may be associated with a greater risk of delayed bleeding whereas polypectomy with a blended cutting current may increase the risk of immediate bleeding. 1,2 In this issue of Gastroenterology, Pohl et al 3 attempt to answer these questions and report on the results of a multicenter randomized controlled singleblinded trial conducted across 18 medical centers between April 2013 and October 2017.…”

mentioning

confidence: 99%

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Polypectomy Using Blended vs Forced Currents: Blue or Yellow? That Is the Question!

Andalib

Gress

2020

Gastroenterology

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mentioning

confidence: 88%

mentioning

confidence: 99%

Polypectomy Using Blended vs Forced Currents: Blue or Yellow? That Is the Question!

Andalib

Gress

2020

Gastroenterology

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“…Deferring EMR of large (20 mm) colorectal polyps for 8 weeks may increase the risk of transition to cancer or progression of unrecognized cancer to more invasive cancer. The risk of covert prevalent cancer in such polyps ranges from 3% to 7%, [19][20][21] with a lower risk where biopsy specimens do not indicate cancer. Although covert cancer may be missed due to sampling error, the likelihood of progression to an unresectable stage within 8 weeks is unlikely.…”

Section: Indications 5 Tomentioning

confidence: 99%

Triaging advanced GI endoscopy procedures during the COVID-19 pandemic: consensus recommendations using the Delphi method

Sawhney

Bilal

Pohl

et al. 2020

Gastrointestinal Endoscopy

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Background and Aims: There is a lack of consensus on which GI endoscopic procedures should be performed during the COVID-19 pandemic, and which procedures could be safely deferred without having a significant impact on outcomes. Methods: We selected a panel of 14 expert endoscopists. We identified 41 common indications for advanced endoscopic procedures from the ASGE Appropriate Use of GI Endoscopy guidelines. Using a modified Delphi method, we first achieved consensus on the patient-important outcome for each procedural indication. Panelists prioritized consensus patient-important outcome when categorizing each indication into one of the following 3 procedural time periods: (1) time-sensitive emergent (schedule within 1 week), (2) time-sensitive urgent (schedule within 1 to 8 weeks), and (3) non-time sensitive (defer for >8 weeks and then reassess the timing). Three anonymous rounds of voting were allowed before attempts at consensus were abandoned. Results: All 14 invited experts agreed to participate in the study. The prespecified consensus threshold of 51% was achieved for assigning patient-important outcome(s) to each advanced endoscopy indication. The prespecified consensus threshold of 66.7% was achieved for 40 of 41 advanced endoscopy indications in stratifying them into 1 of 3 procedural time periods. For 12 of 41 indications, 100% consensus was achieved; for 20 of 41 indications, 75% to 99% consensus was achieved. Conclusions: By using a Modified Delphi method that prioritized patient-important outcomes, we developed consensus recommendations on procedural timing for common indications for advanced endoscopy. These recommendations and the structured decision framework provided by our study can inform decision making as endoscopy services are reopened. (Gastrointest Endosc 2020;92:535-42.)

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“…Clip closure was the primary intervention. The analysis of the effect of clipping and that of the effect of electrocautery are reported elsewhere [10,13].…”

Section: Patient Selection and Study Designmentioning

confidence: 99%

Factors associated with complete clip closure after endoscopic mucosal resection of large colorectal polyps

et al. 2020

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Background. Delayed bleeding is a common adverse event following endoscopic mucosal resection (EMR) of large colorectal polyps. Prophylactic clip closure of the mucosal defect after EMR of ≥20 mm non-pedunculated polyps reduces the incidence of severe delayed bleeding, especially in proximal polyps. Aim: Evaluate factors associated with complete prophylactic clip closure of the mucosal defect after EMR of large polyps. Methods: This is a post-hoc analysis of the CLIP STUDY (NCT01936948). All patients randomized to the clip group were included. Main outcome was complete clip closure of the mucosal resection defect. The defect was considered completely closed when there was no remaining visible mucosal defect and clips were <1cm apart. Factors associated with complete closure were evaluated in multivariable analysis. Results: 458 patients (age 65, 58% men) with 494 large polyps were included. Complete clip closure of the resection defect was achieved for 338 polyps (68.4%) and was not complete for 156 (31.6%). Factors associated with complete closure in adjusted analysis were smaller polyp size (OR 1.06 for every mm decrease [1.02-1.08]), good access (OR 3.58 [1.94-9.59]), complete submucosal lifting (OR 2.28 [1.36-3.90]), en bloc resection (OR 5.75 [1.48-22.39]), and serrated histology (OR 2.74 [1.35-5.56]). Conclusions: Complete clip closure was not achieved for almost 1 out of 3 resected large non-pedunculated polyps. While stable access and en bloc resection facilitate clip closure, most factors associated with clip closure are not modifiable and highlight the need for alternative closure options and preventative bleeding measures.

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Effects of Blended (Yellow) vs Forced Coagulation (Blue) Currents on Adverse Events, Complete Resection, or Polyp Recurrence After Polypectomy in a Large Randomized Trial

Cited by 40 publications

References 22 publications

Polypectomy Using Blended vs Forced Currents: Blue or Yellow? That Is the Question!

Polypectomy Using Blended vs Forced Currents: Blue or Yellow? That Is the Question!

Triaging advanced GI endoscopy procedures during the COVID-19 pandemic: consensus recommendations using the Delphi method

Factors associated with complete clip closure after endoscopic mucosal resection of large colorectal polyps

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