Endoscopic mucosal ablation: a new argon plasma coagulation/injection technique to assist complete resection of recurrent, fibrotic colon polyps (with video).
Gastrointest Endosc
; 75(2): 400-4, 2012 Feb.
Article
em En
| MEDLINE
| ID: mdl-22154411
ABSTRACT
BACKGROUND:
Incomplete piecemeal EMR of large, sessile/flat colon polyps results in polyp recurrence, with massive submucosal scarring making subsequent attempts at endoscopic resection problematic.OBJECTIVE:
We report our experience with a new endoscopic mucosal ablation (EMA) technique that can be used to complement the eradication of recurrent fibrotic colon polyps.DESIGN:
Single-center, retrospective case series.SETTING:
Tertiary-care referral academic endoscopy unit. PATIENTS This study involved consecutive patients referred for endoscopic excision of recurrent benign colon polyps with severe submucosal fibrosis (>30% of the entire lesion). INTERVENTION Application of high-power argon plasma coagulation (APC), preceded by injection of a submucosal fluid cushion (normal saline/diluted adrenaline and/or sodium hyaluronate solution) to protect the muscle layer, was performed to augment further piecemeal EMR and polyp eradication. MAIN OUTCOME MEASUREMENTS Technical safety and success, complication and recurrence rates.RESULTS:
Fourteen patients (mean age 73 years; 9 men, 5 women) with 15 recurrent colon adenomas (mean polyp size 30 mm, 9 proximal/6 distal) were included. EMA with a mean APC power setting of 55 W was applied. Complete polyp eradication was achieved in 9 of 11 patients (82%) at first or second completed follow-up. One patient needed laparoscopic colectomy because of cancer, and 1 underwent transanal endoscopic microsurgery for benign massive recurrence. The other 3 patients with small, easily treatable recurrence (≤3 mm) were followed by 1-year-surveillance. No perforations and no postpolypectomy syndrome were reported.LIMITATIONS:
Single-center, nonrandomized case series with short duration follow-up.CONCLUSION:
EMA appears to be a safe and easily applicable technique to assist the complete eradication of recurrent fibrotic colon polyps.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Pólipos do Colo
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Colonoscopia
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Ablação por Cateter
/
Coagulação com Plasma de Argônio
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Mucosa Intestinal
Idioma:
En
Ano de publicação:
2012
Tipo de documento:
Article