Safety and effectiveness of underwater cold snare resection without submucosal injection of large non-pedunculated colorectal lesions.
Endosc Int Open
; 10(6): E791-E800, 2022 Jun.
Article
en En
| MEDLINE
| ID: mdl-35692912
ABSTRACT
Background and study aims Adverse events are uncommon with cold snaring, but cold techniques are generally reserved for lesions ≤â9âmm out of concern for incomplete resection or inability to mechanically resect larger lesions. In a non-distended, water-filled lumen, colorectal lesions are not stretched, enabling capture and en bloc resection of large lesions. We assessed the effectiveness and safety of underwater cold snare resection (UCSR) without submucosal injection (SI) of ≥â10âmm non-pedunculated, non-bulky (≤â5âmm elevation) lesions with small, thin wire snares. Patients and methods Retrospective analysis of an observational cohort of lesions removed by UCSR during colonoscopy. A single endoscopist performed procedures using a small thin wire (9-mm diameter) cold or (10-mm diameter) hybrid snare. Results Fifty-three lesions (mean 15.8âmm [SD 6.9]; range 10-35âmm) were removed by UCSR from 44 patients. Compared to a historical cohort, significantly more lesions were resected en bloc by UCSR (84.9â% [45/53]; P â=â0.04) compared to conventional endoscopic mucosal resection (EMR) (64.0â% [32/50]). Results were driven by high en bloc resection rates for 10- to 19-mm lesions (97.3â% [36/37]; P â=â0.01). Multiple logistic regression analysis adjusted for potential confounders showed en bloc resection was significantly associated with UCSR compared to conventional EMR (OR 3.47, P â=â0.027). Omission of SI and forgoing prophylactic clipping of post-resection sites did not result in adverse outcomes. Conclusions UCSR ofâ≥â10âmm non-pedunculated, non-bulky colorectal lesions is feasible with high en bloc resection rates without adverse outcomes. Omission of SI and prophylactic clipping decreased resource utilization with economic benefits. UCSR deserves further evaluation in a prospective comparative study.
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Colección:
01-internacional
Base de datos:
MEDLINE
Idioma:
En
Revista:
Endosc Int Open
Año:
2022
Tipo del documento:
Article
País de afiliación:
Estados Unidos