Prioritizing an oncologic approach to endoscopic resection of pedunculated colorectal polyps

Rex, Douglas K.; Risio, Mauro; Hassan, Cesare

doi:10.1016/j.gie.2021.03.003

Cited by 6 publications

(2 citation statements)

References 21 publications

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“…Second, while cold resection was overwhelmingly the most common method of resection identified during the audit (> 96.9% of resections), and while clip use was much less common after cold resection than after resection with electrocautery, clip use after cold resection still accounted for the bulk of clip use during routine screening, surveillance, and diagnostic colonoscopies. Regarding pedunculated polyps, it is our institutional practice to place clips after resection rather than using clips or ligature devices prior to resection in order to maximize the oncologic resection margin in cases of pedunculated polyps harboring malignancy 20 . Clips generate a variable amount of waste depending on manufacturer, but in general lead to higher carbon emissions than either snares or forceps 21 .…”

Section: Discussionmentioning

confidence: 99%

Audit of hemostatic clip use after colorectal polyp resection in an academic endoscopy unit

Stark,

Lahr,

Shultz

et al. 2024

Endosc Int Open

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Background: Prophylactic closure of endoscopic resection defects reduces delayed hemorrhage after resection of non-pedunculated colorectal lesions ≥ 20 mm that are located proximal to the splenic flexure and removed by electrocautery. The risk of delayed hemorrhage after cold (without electrocautery) resection is much lower, and prophylactic clip closure after cold resection is generally unnecessary. Aim: Audit clip use after colorectal polyp resection in routine outpatient colonoscopies at two outpatient centers within an academic medical center. Patients referred for resection of known lesions were excluded. Methods: Retrospective chart analysis performed as part of a quality review of physician adherence to screening and post-polypectomy surveillance intervals. Results: Among 3784 total lesions resected cold by 29 physicians, clips were placed after cold resection on 41.7% of 12 lesions ≥ 20 mm, 19.3% of 207 lesions 10-19 mm in size, and 2.8% of 3565 lesions 1-9 mm in size. Three physicians placed clips after cold resection of lesions 1-9 mm in 18.8%, 25.5%, and 45.0% of cases. These physicians accounted for 8.1% of 1-9 mm resections, but 69.7% of clips placed in this size range. Electrocautery was used for 3.1% of all resections. Clip placement overall after cold resection (3.9%) was much lower than after resection with electrocautery (71.1%), but 62.4% of all clips placed were after cold resection. Conclusions: Audits of clip use in an endoscopy practice can reveal surprising findings, including high and variable rates of unnecessary use after cold resection. Audit can potentially reduce unnecessary costs, carbon emissions, and plastic waste.

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Section: Discussionmentioning

confidence: 99%

Audit of hemostatic clip use after colorectal polyp resection in an academic endoscopy unit

Stark,

Lahr,

Shultz

et al. 2024

Endosc Int Open

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“…For larger pedunculated lesions resected with electrocautery, we favor resection low on the stalk using forced coagulation current, followed by clip placement on the defect after transection. This approach maximizes the chance for a clear margin if cancer invades the stalk (82,102).…”

Section: Resection Techniquesmentioning

confidence: 99%

Performing High-Quality, Safe, Cost-Effective, and Efficient Basic Colonoscopy in 2023: Advice From Two Experts

Anderson

Rex

2023

Am J Gastroenterol

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Based on published evidence and our expert experience, we provide recommendations to maximize the efficacy, safety, efficiency and cost-effectiveness of routine colonoscopy. High quality colonoscopy (HQC) begins with colon preparation using a split or same day dose and preferably a low volume regimen for optimal patient tolerance and compliance. Successful cecal intubation can be achieved by choosing the correct colonoscope as well as using techniques to facilitate navigation through challenges such as severe angulations and redundant colons. Safety is a primary goal and complications such as perforation and splenic rupture can be prevented by avoiding pushing through fixed resistance and avoiding loops in proximal colon. Furthermore, barotrauma can be avoided by converting to water filling only (no gas insufflation) in every patient with a narrowed, angulated sigmoid. Optimal polyp detection relies primarily on compulsive attention to inspection as manifested by adequate inspection time, vigorous probing of the spaces between haustral folds, washing and removing residual debris, and achieving full distention. Achieving minimum recommended ADR thresholds (30% in men and 20% in women) is mandatory, and colonoscopists should aspire to ADRs approaching 50% in screening patients. Distal attachments can improve mucosal exposure and increase detection while shortening withdrawal times. Complete resection of polyps complements polyp detection in preventing colorectal cancer. Cold resection is the preferred method for all polyps < 10 mm. For effective cold resection, an adequate rim of normal tissue should be captured in the snare. Finally, cost-effective HQC requires the procedure not be overused, as demonstrated by following updated USMSTF post-polypectomy surveillance recommendations.

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Large-diameter cap for fast-track forceps scissor-based endoscopic submucosal dissection

Zimmer

Eltze²

2021

Tech Coloproctol

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Prioritizing an oncologic approach to endoscopic resection of pedunculated colorectal polyps

Cited by 6 publications

References 21 publications

Audit of hemostatic clip use after colorectal polyp resection in an academic endoscopy unit

Audit of hemostatic clip use after colorectal polyp resection in an academic endoscopy unit

Performing High-Quality, Safe, Cost-Effective, and Efficient Basic Colonoscopy in 2023: Advice From Two Experts

Large-diameter cap for fast-track forceps scissor-based endoscopic submucosal dissection

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