Wide Field Endoscopic Resection for Advanced Colonic Mucosal Neoplasia: Current Status and Future Directions

Quality indicators for colonoscopy

“…Effective methods of reducing delayed bleeding from large sessile and flat lesions remains uncertain but, as noted earlier, the risk may be related to cautery type. Some experts advocate the use of microprocessorcontrolled alternating coagulation and/or cutting currents to limit thermal injury and reduce the delayed bleeding risk when these lesions are resected, 140 but controlled evidence is lacking. 14.…”

“…Many sessile polyps O2 cm in size are removable endoscopically, depending on their location within the colon, their size, and the ability to access them endoscopically. 139,140 Endoscopic resection is more cost effective and safer than surgical resection. 137 If referral to another endoscopist is anticipated for resection of a large sessile lesion, then the endoscopist should avoid snare resection of any part of the polyp if possible, because such a partial resection will result in a false-positive non-lifting sign that can make the subsequent attempt at endoscopic resection more difficult.…”

Improving complete EMR of colorectal neoplasia: a randomized trial comparing snares and injectate in the resection of large sessile colon polyps

“…Total en bloc excision is the preferred outcome because it has the advantage of decreased recurrence and accurate histologic assessment. 2,3 Snare techniques in the colon use free-hand snare resection after submucosal injection. Snare selection is based on lesion size, morphology, location, and complexity.…”

Polidocanol injection decreases the bleeding rate after colon polypectomy: a propensity score analysis

“…25 Succinylated gelatin seems to fulfil these criteria, but a recent randomized, controlled trial, although showing a significant improvement in efficacy outcomes, failed to find decreased PPB and perforation rate after gelatin submucosal injection compared with saline solution. 12 Polidocanol has been known as a sclerosing agent for several years and is widely used in the treatment of esophageal varices, hemangiomas, and hemorrhoids.…”

“…The median lesion size detected was 32 mm (IQR, [25][26][27][28][29][30][31][32][33][34][35][36][37][38] in the polidocanol group and 32 mm (IQR, 24-38) in the epinephrine group (P Z .7).…”