Efficacy of precutting endoscopic mucosal resection with full or partial circumferential incision using a snare tip for difficult colorectal lesions

Abstract

Background We analyzed the efficacy of precutting endoscopic mucosal resection (EMR), which is a method of making a full or partial circumferential mucosal incision around a tumor with a snare tip for en bloc resection. Methods We reviewed cases from 2011 to 2018 in which precutting EMR (n = 167) and standard EMR (n = 557) were performed for lesions of 10 – 30 mm. Precutting EMR was indicated for benign lesions of 20 – 30 mm or lesions of < 20 mm for which standard EMR was difficult. Through propensity score matching of the two groups, the therapeutic outcomes for 35 lesions of ≥ 20 mm and 98 lesions of < 20 mm in each group were analyzed. Results In the two sizes of lesion, there were significant differences between the precutting and standard groups in the en bloc resection rate (≥ 20 mm 88.6 % vs. 48.5 %, P < 0.001; < 20 mm 98.0 % vs. 85.7 %, P = 0.004) and the histological complete resection rate (≥ 20 mm 71.4 % vs. 42.9 %, P = 0.02; < 20 mm 87.8 % vs. 67.3 %, P < 0.001). Conclusion Precutting EMR enabled high en bloc resection rates in cases involving difficult lesions.

Cold snare polypectomy for large sessile serrated lesions is safe but follow‐up is needed: a single‐centre retrospective study

“…All lesions with dysplasia had a smooth appearance, without any depression or polypoid area. Among the 101 lesions that were Follow-up period, month, median (IQR) 18 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) Overall recurrence rate, % (n) 5.0 (5/101) Abbreviations: CSP, cold snare polypectomy; HGD, high-grade dysplasia; IQR, interquartile range; left-sided, descending colon to rectum; LGD, lowgrade dysplasia; right-sided, caecum to transverse colon; SD, standard deviation; SSL, sessile serrated lesion.…”

“…The rates of recurrence after hot polypectomy, endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are reported to be 0.3%, 1.4% and 2.3%, respectively. 20,21 Regarding recurrence after CSP for lesions of any histology ≥10 mm in size, a systematic review of eight studies for which CSP was indicated for adenoma and SSL was reported. 22 There were five reports of piecemeal CSP from the USA, the UK and Australia, focusing on SSLs ≥10 mm in size, 14,15,[23][24][25] although two studies included 33.3% and 51.4% low-grade adenoma.…”

“…Additionally, we tried to achieve en bloc resection for all lesions so that enough margins were not obtained compared to piecemeal CSP. The rates of recurrence after hot polypectomy, endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are reported to be 0.3%, 1.4% and 2.3%, respectively 20,21 . Regarding recurrence after CSP for lesions of any histology ≥10 mm in size, a systematic review of eight studies for which CSP was indicated for adenoma and SSL was reported 22 .…”

A knife plus a snare, but how will it fare?

“…The tip of a conventional snare has been used instead of a knife in hybrid EMR but is much bulkier and unwieldy. 4 Recently, 2 multifunctional snares have been designed to facilitate the performance of hybrid EMR (Souten, Kaneka Medics, Tokyo, Japan; Ksnare, Pentax Medical, Tokyo, Japan). Both snares feature a straight noninsulated knife-tip that, when partially opened in the sheath, can be used for marking, mucosal incision, and submucosal dissection.…”

Disruption in colonic polypectomy: rocking the trend

“…We therefore read with interest the study by Yoshida et al, which describes the efficacy of EMR-P on benign colorectal lesions 20 -30 mm in size, or lesions 10 -19 mm in size for which standard EMR was difficult (lesions in challenging locations [i. e. right colon or behind folds], flat morphology, poor submucosal lifting, or poor endoscope access) [4]. Either a full or partial circumferential incision was made using the snare tip, although a full circumferential incision was made in the vast majority of the lesions.…”