Arvind J Trindade1, Nikhil A Kumta2, Manoop S Bhutani3, Vinay Chandrasekhara4, Pichamol Jirapinyo5, Kumar Krishnan6, Joshua Melson7, Rahul Pannala8, Mansour A Parsi9, Allison R Schulman10, Guru Trikudanathan11, Rabindra R Watson12, John T Maple13, David R Lichtenstein14. 1. Division of Gastroenterology, Mount Sinai Hospital, New York, New York, USA. 2. Department of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, New Hyde Park, New York, USA. 3. Department of Gastroenterology, Hepatology and Nutrition, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. 4. Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA. 5. Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA. 6. Division of Gastroenterology, Department of Internal Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, USA. 7. Division of Digestive Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA. 8. Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA. 9. Section for Gastroenterology and Hepatology, Tulane University Health Sciences Center, New Orleans, Louisiana, USA. 10. Department of Gastroenterology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA. 11. Department of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA. 12. Department of Gastroenterology, Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA. 13. Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA. 14. Division of Gastroenterology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA.
Abstract
BACKGROUND AND AIMS: Residual neoplasia after macroscopically complete EMR of large colon polyps has been reported in 10% to 32% of resections. Often, residual polyps at the site of prior polypectomy are fibrotic and nonlifting, making additional resection challenging. METHODS: This document reviews devices and methods for the endoscopic treatment of fibrotic and/or residual polyps. In addition, techniques reported to reduce the incidence of residual neoplasia after endoscopic resection are discussed. RESULTS: Descriptions of technologies and available outcomes data are summarized for argon plasma coagulation ablation, snare-tip coagulation, avulsion techniques, grasp-and-snare technique, EndoRotor endoscopic resection system, endoscopic full-thickness resection device, and salvage endoscopic submucosal dissection. CONCLUSIONS: Several technologies and techniques discussed in this document may aid in the prevention and/or resection of fibrotic and nonlifting polyps.
BACKGROUND AND AIMS: Residual neoplasia after macroscopically complete EMR of large colon polyps has been reported in 10% to 32% of resections. Often, residual polyps at the site of prior polypectomy are fibrotic and nonlifting, making additional resection challenging. METHODS: This document reviews devices and methods for the endoscopic treatment of fibrotic and/or residual polyps. In addition, techniques reported to reduce the incidence of residual neoplasia after endoscopic resection are discussed. RESULTS: Descriptions of technologies and available outcomes data are summarized for argon plasma coagulation ablation, snare-tip coagulation, avulsion techniques, grasp-and-snare technique, EndoRotor endoscopic resection system, endoscopic full-thickness resection device, and salvage endoscopic submucosal dissection. CONCLUSIONS: Several technologies and techniques discussed in this document may aid in the prevention and/or resection of fibrotic and nonlifting polyps.
Authors: Vinay Chandrasekhara; Nikhil A Kumta; Barham K Abu Dayyeh; Manoop S Bhutani; Pichamol Jirapinyo; Kumar Krishnan; John T Maple; Joshua Melson; Rahul Pannala; Mansour A Parsi; Amrita Sethi; Guru Trikudanathan; Arvind J Trindade; David R Lichtenstein Journal: VideoGIE Date: 2021-04-02