BACKGROUND: EMR of large sessile polyps and laterally spreading tumors (LSTs) of the colon is safe and cost-effective. Perforation remains a feared and well-recognized complication; however, endoscopic detection is often absent, and most commonly, diagnosis is delayed and depends on clinical signs and/or radiology findings. To date, an endoscopic sign to identify muscularis propria (MP) resection and potential perforation has not been described. OBJECTIVE: To describe an endoscopic sign for prompt recognition of EMR-related MP resection. DESIGN: Prospective analysis. SETTINGS: Tertiary referral academic gastroenterology unit. PATIENTS: Patients with the target sign were identified prospectively in 2 large prospective studies of EMR for colonic LSTs 20 mm or larger. INTERVENTION: A standardized EMR approach was used. MP defects were closed endoscopically with clips. MAIN OUTCOME MEASUREMENTS: The presence or absence of the target sign in the polypectomy specimen and its influence on subsequent endoscopic management of polypectomy complications. RESULTS: A total of 445 patients with LSTs or sessile polyps 20 mm or larger (mean size 33 mm, range 20-85 mm) were prospectively enrolled in 2 studies. Ten patients (mean age 70.3 years, range 48-83 years, 50% male) with target lesions and histologically confirmed MP resection were identified prospectively at the time of EMR, with 3 having full-thickness resection. All cases were identified intraprocedurally by a target sign on the underside of the specimen and a mirror target evident in the mucosal defect. All patients were treated endoscopically with 1 to 5 endoscopic clips. None required operative management. Thirteen inpatient days were required to treat the 10 patients (mean 1.3 days). LIMITATIONS: Nonrandomized study. CONCLUSIONS: Careful analysis of the post-EMR specimen and resection defect may reveal a target sign, an easily recognized and reliable marker of either partial- or full-thickness MP resection and potential perforation. Prompt recognition of this sign facilitates endoscopic management.
BACKGROUND: EMR of large sessile polyps and laterally spreading tumors (LSTs) of the colon is safe and cost-effective. Perforation remains a feared and well-recognized complication; however, endoscopic detection is often absent, and most commonly, diagnosis is delayed and depends on clinical signs and/or radiology findings. To date, an endoscopic sign to identify muscularis propria (MP) resection and potential perforation has not been described. OBJECTIVE: To describe an endoscopic sign for prompt recognition of EMR-related MP resection. DESIGN: Prospective analysis. SETTINGS: Tertiary referral academic gastroenterology unit. PATIENTS: Patients with the target sign were identified prospectively in 2 large prospective studies of EMR for colonic LSTs 20 mm or larger. INTERVENTION: A standardized EMR approach was used. MP defects were closed endoscopically with clips. MAIN OUTCOME MEASUREMENTS: The presence or absence of the target sign in the polypectomy specimen and its influence on subsequent endoscopic management of polypectomy complications. RESULTS: A total of 445 patients with LSTs or sessile polyps 20 mm or larger (mean size 33 mm, range 20-85 mm) were prospectively enrolled in 2 studies. Ten patients (mean age 70.3 years, range 48-83 years, 50% male) with target lesions and histologically confirmed MP resection were identified prospectively at the time of EMR, with 3 having full-thickness resection. All cases were identified intraprocedurally by a target sign on the underside of the specimen and a mirror target evident in the mucosal defect. All patients were treated endoscopically with 1 to 5 endoscopic clips. None required operative management. Thirteen inpatient days were required to treat the 10 patients (mean 1.3 days). LIMITATIONS: Nonrandomized study. CONCLUSIONS: Careful analysis of the post-EMR specimen and resection defect may reveal a target sign, an easily recognized and reliable marker of either partial- or full-thickness MP resection and potential perforation. Prompt recognition of this sign facilitates endoscopic management.
Authors: Khalid N Alsowaina; Mooyad A Ahmed; Nawar A Alkhamesi; Ahmad I Elnahas; Jeffrey D Hawel; Nitin V Khanna; Christopher M Schlachta Journal: Surg Endosc Date: 2019-08-26 Impact factor: 4.584
Authors: Matthew D Rutter; Amit Chattree; Jamie A Barbour; Siwan Thomas-Gibson; Pradeep Bhandari; Brian P Saunders; Andrew M Veitch; John Anderson; Bjorn J Rembacken; Maurice B Loughrey; Rupert Pullan; William V Garrett; Gethin Lewis; Sunil Dolwani Journal: Gut Date: 2015-06-23 Impact factor: 23.059