Introduction The current management of large colonic polyps is endoscopic resection via endoscopic mucosal resection (EMR). This widely practiced technique is evidently safe but carries a risk of polyp recurrence with rates varying between 10%–15% in polyps larger than 20 mm in size. Post-EMR recurrences are often scarred and there is a loss of the submucosal planes. This makes endoscopic management of these polyps very challenging with a high risk of complications. EndoRotor is a novel non-diathermic EMR device designed to reduce diathermy related complications (eg. perforation and delayed bleeding). We present a video demonstrating the use of a novel non-diathermic EMR device in the management of a scarred polyp.
Method The novel non-diathermic device contains a fixed outer cannula and a rotating inner cannula. There is an opening at the end of both cannulas. There is an opening of both cannulas where tissue is sucked into and dissected by the rotating inner cannula. The dissected tissue is then transported into a tissue trap as the polyp is being treated. The device does not employ the use of diathermy thereby reducing the risk of perforation and delayed bleeding.
Results A 55-year-old female who had a multi-piece EMR for a 50 mm laterally spreading tumour in the recto-sigmoid junction was found to have a 10 mm residual tissue in the resection base during her 3 month post-EMR check. The histology of the resected tissue was reported to show tubulovillous adenoma with low grade dysplasia. Endoscopic assessment demonstrated a scarred polyp with predominantly Type III surface pattern. The polyp was overlying 1 fold and encompassed less than 20% of the lumen circumference. Lifting solution consisting of gelofusine, indigo carmine and dilute adrenaline was injected around the polyp. However, due to scarring, there no lift was obtained. EndoRotor was then used to successfully resect the polyp without the need for diathermy. Pooled fluid in the lumen was removed using the same device.
Conclusion Scarred polyps can be very challenging to manage endoscopically as the submucosal plane is often lost due to fibrosis. This heightens the risk of perforation and delayed bleeding when traditional endoscopic resection techniques are applied. EndoRotor is a novel device that is able to resect scarred polyps without the use of diathermy.
Disclosure of Interest K. Kandiah: None Declared, S Subramaniam: None Declared, P Bhandari Conflict with: Receives educational grants from Fujifilm, Olympus and Pentax
- Endoscopic mucosal resection (EMR)
- non-diathermic device
- scarred polyp