Devices and techniques for endoscopic treatment of residual and fibrotic colorectal polyps (with videos)

Arvind J Trindade; Nikhil A Kumta; Manoop S Bhutani; Vinay Chandrasekhara; Pichamol Jirapinyo; Kumar Krishnan; Joshua Melson; Rahul Pannala; Mansour A Parsi; Allison R Schulman; Guru Trikudanathan; Rabindra R Watson; John T Maple; David R Lichtenstein

doi:10.1016/j.gie.2020.03.018

Devices and techniques for endoscopic treatment of residual and fibrotic colorectal polyps (with videos)

Gastrointest Endosc. 2020 Sep;92(3):474-482. doi: 10.1016/j.gie.2020.03.018. Epub 2020 Jul 5.

Authors

Affiliations

¹ Division of Gastroenterology, Mount Sinai Hospital, New York, New York, USA.
² Department of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, New Hyde Park, New York, USA.
³ Department of Gastroenterology, Hepatology and Nutrition, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
⁴ Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
⁵ Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA.
⁶ Division of Gastroenterology, Department of Internal Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, USA.
⁷ Division of Digestive Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA.
⁸ Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA.
⁹ Section for Gastroenterology and Hepatology, Tulane University Health Sciences Center, New Orleans, Louisiana, USA.
¹⁰ Department of Gastroenterology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA.
¹¹ Department of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA.
¹² Department of Gastroenterology, Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA.
¹³ Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
¹⁴ Division of Gastroenterology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA.

PMID: 32641215
DOI: 10.1016/j.gie.2020.03.018

Abstract

Background and aims: Residual neoplasia after macroscopically complete EMR of large colon polyps has been reported in 10% to 32% of resections. Often, residual polyps at the site of prior polypectomy are fibrotic and nonlifting, making additional resection challenging.

Methods: This document reviews devices and methods for the endoscopic treatment of fibrotic and/or residual polyps. In addition, techniques reported to reduce the incidence of residual neoplasia after endoscopic resection are discussed.

Results: Descriptions of technologies and available outcomes data are summarized for argon plasma coagulation ablation, snare-tip coagulation, avulsion techniques, grasp-and-snare technique, EndoRotor endoscopic resection system, endoscopic full-thickness resection device, and salvage endoscopic submucosal dissection.

Conclusions: Several technologies and techniques discussed in this document may aid in the prevention and/or resection of fibrotic and nonlifting polyps.

MeSH terms

Colonic Polyps* / pathology
Colonic Polyps* / surgery
Colonoscopy
Colorectal Neoplasms / pathology
Colorectal Neoplasms / surgery
Endoscopic Mucosal Resection
Humans
Intestinal Mucosa / pathology
Neoplasm, Residual / pathology
Practice Guidelines as Topic