Cold-forceps avulsion with adjuvant snare-tip soft coagulation (CAST) is an effective and safe strategy for the management of non-lifting large laterally spreading colonic lesions.
Endoscopy
; 50(1): 52-62, 2018 01.
Article
em En
| MEDLINE
| ID: mdl-29020690
ABSTRACT
BACKGROUND AND AIMS:
Non-lifting large laterally spreading colorectal lesions (LSLs) are challenging to resect endoscopically and often necessitate surgery. A safe, simple technique to treat non-lifting LSLs endoscopically with robust long-term outcomes has not been described.METHODS:
In this single-center prospective observational study of consecutive patients referred for endoscopic mucosal resection (EMR) of LSLs ≥â20âmm, LSLs not completely resectable by snare because of non-lifting underwent standardized completion of resection with cold-forceps avulsion and adjuvant snare-tip soft coagulation (CAST). Scheduled surveillance colonoscopies were performed at 4â-â6 months (SC1) and 18 months (SC2). Primary outcomes were endoscopic evidence of adenoma clearance and avoidance of surgery. The secondary outcome was safety.RESULTS:
From January 2012 to October 2016, 540 lifting LSLs (82.2â%) underwent complete snare excision at EMR. CAST was required for complete removal in 101 non-lifting LSLs (17.8â%) 63 naïve non-lifting lesions (NNLs; 62.7â%) and 38 previously attempted non-lifting lesions (PANLs; 37.3â%). PANLs were smaller (Pâ<â0.001) and more likely to be non-granular (Pâ=â0.001) than the lifting LSLs. NNLs were of similar size (Pâ=â0.77) and morphology (Pâ=â0.10) to the lifting LSLs. CAST was successful in all cases and adverse events were comparable to lifting LSLs resected by complete snare excision. Recurrence at SC1 was comparable for PANLs (15.2â%) and lifting LSLs (15.3â%; Pâ=â0.99), whereas NNLs recurred more frequently (27.5â%; Pâ=â0.049); however, surgery was no more common for either type of non-lifting LSL than for lifting LSLs.CONCLUSION:
CAST is a safe, effective, and surgery-sparing therapy for the majority of non-lifting LSLs. It is easy to use, inexpensive, and does not require additional equipment.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Adenoma
/
Neoplasias do Colo
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Ressecção Endoscópica de Mucosa
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Recidiva Local de Neoplasia
Tipo de estudo:
Observational_studies
Limite:
Aged
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
Endoscopy
Ano de publicação:
2018
Tipo de documento:
Article
País de afiliação:
Austrália