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Original research
Histopathological effects of electrosurgical interventions in an in vivo porcine model of colonic endoscopic mucosal resection
  1. Anthony M Whitfield1,2,
  2. Nicholas G Burgess1,2,
  3. Farzan F Bahin1,2,
  4. Sharir Kabir3,
  5. María Pellisé4,
  6. Rebecca Sonson2,
  7. Vishnu Subramanian3,
  8. Hema Mahajan5,
  9. Duncan McLeod5,
  10. Karen Byth6,7,
  11. Michael J Bourke1,2
  1. 1Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
  2. 2Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
  3. 3Department of General Surgery, Westmead Hospital, Westmead, New South Wales, Australia
  4. 4Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
  5. 5Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, New South Wales, Australia
  6. 6NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
  7. 7WSLHD Research and Education Network, Westmead Hospital, Westmead, New South Wales, Australia
  1. Correspondence to Dr Michael J Bourke, Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia; michael{at}citywestgastro.com.au

Abstract

Objective Endoscopic mucosal resection (EMR) in the colon has been widely adopted, but there is limited data on the histopathological effects of the differing electrosurgical currents (ESCs) used. We used an in vivo porcine model to compare the tissue effects of ESCs for snare resection and adjuvant margin ablation techniques.

Design Standardised EMR was performed by a single endoscopist in 12 pigs. Two intersecting 15 mm snare resections were performed. Resections were randomised 1:1 using either a microprocessor-controlled current (MCC) or low-power coagulating current (LPCC). The lateral margins of each defect were treated with either argon plasma coagulation (APC) or snare tip soft coagulation (STSC). Colons were surgically removed at 72 hours. Two specialist pathologists blinded to the intervention assessed the specimens.

Results 88 defects were analysed (median 7 per pig, median defect size 29×17 mm). For snare ESC effects, 156 tissue sections were assessed. LPCC was comparable to MCC for deep involvement of the colon wall. For margin ablation, 172 tissue sections were assessed. APC was comparable to STSC for deep involvement of the colon wall. Islands of preserved mucosa at the coagulated margin were more likely with APC compared with STSC (16% vs 5%, p=0.010).

Conclusion For snare resection, MCC and LPCC did not produce significantly different tissue effects. The submucosal injectate may protect the underlying tissue, and technique may more strongly dictate the depth and extent of final injury. For margin ablation, APC was less uniform and complete compared with STSC.

  • colonoscopy
  • colonic polyps
  • colorectal cancer
  • endoscopic polypectomy

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Contributors AMW organised and analysed the data, performed a statistical analysis of the data, wrote the manuscript and revised the manuscript after review by the coauthors. NGB designed the study, collected and analysed the data, cowrote the manuscript and revised the manuscript after review by the coauthors. FFB, MP, RS collected data, reviewed and revised the manuscript. SK performed surgical procedures and reviewed and revised the manuscript. VS, HM and DMcL collected and organised the data, examined histological and pathological specimens and critically reviewed the manuscript. KB performed a statistical analysis of data and reviewed and revised the manuscript. MJB initiated, designed and led the study, and performed the procedures, collected the data, and cowrote and critically reviewed the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests MJB received research support from Olympus Medical, Cook Medical and Boston Scientific.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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