Large sessile colonic adenomas: use of argon plasma coagulator to supplement piecemeal snare polypectomy

Zlatanic, Jusuf; Waye, Jerome D.; Kim, Peter; Baiocco, Peter J.; Gleim, Gilbert W.

doi:10.1016/s0016-5107(99)70291-9

Cited by 168 publications

(116 citation statements)

References 20 publications

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“…This meta-analysis revealed that en-bloc resection was achieved in 62.85% of lesions and tumor-free vertical and lateral margins were achieved in 58.6%. These results compare well to en-bloc resection rates achieved by conventional polypectomy snare, which have been reported Imai et al [24] , 1999 Snare 30 No information EMR 3 Igarashi et al [25] , 1999 Snare 884 No information EMR 4 Oka et al [26] , 2005 Snare 410 Lateral spreading tumor EMR 5 Sano et al [27] , 2004 Snare 392 Lateral spreading tumor EMR 6 Hotta et al [28] , 2003 Snare 284 Protrusion 68, flat 213, depressed 3 EMR 7…”

Section: Discussionsupporting

confidence: 86%

“…Large sessile and flat polyps represent a major technical challenge to conventional snare resection. Additional procedures and therapies such as Argon plasma coagulation are frequently needed to destroy remnant tissue after resection [5] . When these techniques are not used or possible, patients are frequently referred for surgical resection [6] .…”

Section: Introductionmentioning

confidence: 99%

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Meta-analysis and systematic review of colorectal endoscopic mucosal resection

Puli¹,

Kakugawa²,

Gotoda³

et al. 2009

WJG

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AIM:To evaluate the proportion of successful complete cure en-bloc resections of large colorectal polyps achieved by endoscopic mucosal resection (EMR). METHODS:Studies using the EMR technique to resect large colorectal polyps were selected. Successful complete cure en-bloc resection was defined as one piece margin-free polyp resection. Articles were searched for in Medline, Pubmed, and the Cochrane Control Trial Registry, among other sources. RESULTS:An initial search identified 2620 reference articles, from which 429 relevant articles were selected and reviewed. Data was extracted from 25 studies (n = 5221) which met the inclusion criteria. All the studies used snares to perform EMR. Pooled proportion of en-bloc resections using a random effect model was 62.85% (95% CI: 51.50-73.52). The pooled proportion for complete cure en-bloc resections using a random effect model was 58.66% (95% CI: 47.14-69.71). With higher patient load (> 200 patients), this complete cure en-bloc resection rate improves from 44.19% (95% CI:24.31-65.09) to 69.17% (95% CI: 51.11-84.61). CONCLUSION:EMR is an effective technique for the resection of large colorectal polyps and offers an alternative to surgery.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Meta-analysis and systematic review of colorectal endoscopic mucosal resection

Puli¹,

Kakugawa²,

Gotoda³

et al. 2009

WJG

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“…In this study, we described a series of 1354 endoscopic resections of colon rectal polyps performed in our endoscopic units between January, 1996 and May, 2006. The gender and age distribution of patients is similar to that described above in other studies regarding the treatment of colorectal polyps [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] . From the literature, it emerges that over 80% of polyps resected during colonoscopy are small polyps less than 10 mm in diameter [24] while in our study 67% were 10 mm in diameter.…”

Section: Discussionsupporting

confidence: 59%

“…Large polyps represent a particular challenge for the endoscopist because they are often related to important risks of haemorrhage (0%-22.1%), perforation (0%-1.3%) and inadequate polypectomy [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] . The alternative to endoscopic therapy of large polyps is the surgical resection which involves hospitalization and anaesthesia.…”

Section: Introductionmentioning

confidence: 99%

Efficacy, risk factors and complications of endoscopic polypectomy: Ten year experience at a single center

Consolo¹,

Luigiano²,

Strangio³

et al. 2008

WJG

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AIM:To examine the efficacy and complications of colonoscopic resection of colorectal polypoid lesions. M E T H O D S :We r e t r o s p e c t i v e l y r e v i e w e d 1 3 5 4 polypectomies performed on 1038 patients over a tenyear period. One hundred and sixty of these were performed for large polyps, those measuring ≥ 20 mm. Size, shape, location, histology, the technique of polypectomy used, complications, drugs assumption and associated intestinal or extra intestinal diseases were analyzed. For statistical analysis, the Pearson χ 2 test, NPC test and a Binary Logistic Regression were used. RESULTS:The mean patient age was 65.9 ± 12.4 years, with 671 men and 367 women. The mean size of polyps removed was 9.45 ± 9.56 mm while the size of large polyps was 31.5 ± 10.8 mm. There were 388 pedunculated and 966 sessile polyps and the most common location was the sigmoid colon (41.3%). The most frequent histology was tubular adenoma (55.9%) while for the large polyps was villous (92/160 -57.5%). Coexistent malignancy was observed in 28 polyps (2.1%) and of these, 20 were large polyps. There were 17 procedural bleeding (1.3%) and one perforation. The statistical analysis showed that cancer is correlated to polyp size (P < 0.0001); sessile shape (P < 0.0001) and bleeding are correlated to cardiac disease (P = 0.034), tubular adenoma (P = 0.016) and polyp size. CONCLUSION:The endoscopic resection is a simple and safe procedure for removing colon rectal neoplastic lesions and should be considered the treatment of choice for large colorectal polyps. The polyp size is an important risk factor for malignancy and for bleeding.

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“…С 1991 г. в «гибкой» эндоскопии получил распространение метод АПК, обладающий 2 важными качествами: с одной стороны, обеспечивает эффектив-ную коагуляцию обширных поверхностей, с другой -позволяет выполнять коагуляцию при хорошо регули-руемой и равномерной глубине проникновения [26]. АПК применяют для снижения частоты рецидива при фрагментарном удалении диатермической петлей аденом прямой и ободочной кишки [27][28][29][30][31][32]. В насто-ящем исследовании мы стремились дать свою оценку данному методу при удалении LST-G с низким риском подслизистой инвазии, локализованных в прямой кишке.…”

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Argon plasma coagulation in coloproctology: clinical experience with and prospects for the technique

Десятов¹,

Aliev²

2015

Onkol. koloproktol.

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Large sessile colonic adenomas: use of argon plasma coagulator to supplement piecemeal snare polypectomy

Cited by 168 publications

References 20 publications

Meta-analysis and systematic review of colorectal endoscopic mucosal resection

Meta-analysis and systematic review of colorectal endoscopic mucosal resection

Efficacy, risk factors and complications of endoscopic polypectomy: Ten year experience at a single center

Argon plasma coagulation in coloproctology: clinical experience with and prospects for the technique

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