Background: Endoscopic management of the nonlifting areas of a colonic polyp is a significant challenge. The traditional approach has been to use ablative techniques with mixed long-term results.
Objective: To evaluate the safety and efficacy of hot avulsion (HA), a modification in the use of hot biopsy forceps in the management of the nonlifting areas of a colonic polyp.
Design: Retrospective review of data from a prospectively maintained colonic Endoscopic Mucosal Resection database.
Setting: Tertiary referral hospital.
Patients and intervention: Twenty patients in whom HA was used as part of the polypectomy technique.
Main outcome measurements: Location and size of polyp, reasons for nonlifting, immediate success, residual rates, and adverse events.
Results: In our 20 patients studied, the main reasons for nonlifting were scarring from previous EMR attempts in 55% and scarring from previous biopsy in 35%. Mean size of avulsion was 4.4 mm (range, 1-15 mm). At the index procedure, HA was successful in removing macroscopic adenomatous tissue in all patients. At follow-up examinations, 85% (17/20) had no macroscopic or microscopic neoplasia residual and 15% (3/20) had a small area of residual that was easily treated with repeat HA. There were no immediate or long-term adverse events.
Limitations: Nonrandomized, single-center experience.
Conclusions: HA appears to be a safe and effective adjunct treatment to snare polypectomy for nonlifting areas of a colonic polyp. Further randomized multicenter studies are required with direct comparison to established techniques.
Copyright © 2014. Published by Elsevier Inc.