Introduction Endoscopic submucosal dissection (ESD) can be a highly effective technique for the en-bloc removal of complex colorectal lesions, but is technically challenging and associated with a higher incidence of adverse events. In light of this, hybrid knife assisted resection (KAR)1 method has been previously described.
We describe a novel technique of snare tip assisted resection (STAR), its indications for use, and our observed outcomes so far.
Method All data was recorded prospectively from June 2014 to February 2017. All procedures were performed by a single endoscopist.
‘Complex’ colorectal lesions were defined as those with features suggestive of early malignancy, recurrent lesions, scarred lesions from previous incomplete resection, and for lesions identified in patients with colitis. STAR was also used to assist snare resection of polyps with flat components.
Lesions are lifted with a standard EMR solution. The tip of a stiff spiral snare is advanced by 1–2 mm, and using endocut current a deep submucosal incision is made and subsequently extended circumferentially via a tapping technique. The snare is then opened and engaged within the groove in order to complete the resection.
Results STAR resection was used for 51 lesions amongst 50 patients. Lesion size varied from 0.5–7 cm (mean 2.6 cm).
Of the 51 lesions, two thirds (34) were felt to have endoscopic features suggestive of early malignancy. Using the STAR technique, en-bloc resection was successful in 19/34 (56%). Upon histological analysis, cancer was identified in 11 (32%) specimens and focal high grade dysplasia in another 8 (24%). Of the cancerous lesions, 9 had complete endoscopic resection, of which 4 had a curative sm1R0 resection requiring no further treatment.
Using STAR technique, 10 scarred lesions and 7 lesions with flat components were also resected.
At present 1 year follow up data is available for 19 patients and 3–6 month data in 12, and reveals no residual or recurrent lesion occurrence to date.
Three patients had adverse events: 2 patients had bleeding complications (one required embolization therapy) and 1 patient had a delayed perforation necessitating surgery. Overall, the significant complication rate was 5.8%
Conclusion STAR is a novel technique and this is the first ever Western reported case series. We would suggest that when adopted by endoscopists with significant experience in EMR/ESD, STAR is an effective, inexpensive, and alternative technique for the management of selective complex colorectal lesions.
. Bhattacharyya R, et al. KAR of large and refractory colonic polyps at a Western centre: Feasibility, safety and efficacy study to guide future practice. UEG Journal. 2016;4(3):466–473.
Disclosure of Interest None Declared
- colorectal polyps
- Endoscopic Mucosal Resection
- Endoscopic submucosal dissection