Browsing by Subject "endoscopic mucosal resection"

Now showing 1 - 10 of 12
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    Advanced Colonoscopy Techniques and Technologies
    (Elsevier, 2015-10) Gromski, Mark A.; Kahi, Charles J.; Department of Medicine, IU School of Medicine
    Colonoscopy is the most frequently performed endoscopic procedure in the United States. It is the mainstay of diagnostic and therapeutic options for the practicing gastroenterologist. It plays a fundamental role in colorectal cancer (CRC) prevention, with a dominant position among the screening options for CRC and precancerous lesions. Over the past decade, there have been significant advances in the field of CRC and colonoscopy, including a better understanding of the importance of right-sided lesions, the sessile serrated pathway, and recognition of the significance of operator dependence in colonoscopy. This has been paralleled by an array of technological and technical advances that has transformed the field of colonoscopy and improved patient care. This article addresses the diverse and expanding field of advanced colonoscopy techniques and technologies. It is intended to be a primer on recent and effective developments in advanced technologies for screening or imaging, mucosal resection techniques, and endoscopic management of CRC.
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    Clip Artifact after Closure of Large Colorectal Endoscopic Mucosal Resection Sites: Incidence and Recognition
    (Elsevier, 2015-08) Sreepati, Gouri; Vemulapalli, Krishna C.; Rex, Douglas K.; Department of Medicine, IU School of Medicine
    Background Clip closure of large colorectal EMR defects sometimes results in bumpy scars that are normal on biopsy. We refer to these as “clip artifact.” If unrecognized, clip artifact can be mistaken for residual polyp, leading to thermal treatment and potential adverse events. Objective To describe the incidence of and define predictors of clip artifact. Design Review of photographs of scars from consecutive clipped EMR defects. Setting University outpatient endoscopy center. Patients A total of 284 consecutive patients with clip closure of defects after EMR of lesions 20 mm or larger and follow-up colonoscopy. Interventions EMR, clip closure. Main Outcome Measurements Incidence of clip artifact. Results A total of 303 large polyps met the inclusion criteria. On review of photographs, 96 scars (31.7%) had clip artifact. Clip artifact was associated with increased numbers of clips placed (odds ratio for each additional clip, 1.2; 95% confidence interval, 1.02-1.38) but not polyp histology, size, or location. The rate of residual polyp by histology was 8.9% (27/303), with 21 of 27 scars with residual polyp evident endoscopically. The rate of residual polyp evident only by histology in scars with clip artifact (3/93; 3.2%) was not different from the rate in scars without clip artifact (3/189; 1.6%). Limitations Retrospective design. Sites closed primarily with 1 type of clip. Single-operator assessment of endoscopic photographs. Conclusion Clip artifact occurred in the scars of approximately one-third of large clipped EMR sites and increased with number of clips placed. Clip artifact could be consistently distinguished from residual polyp by its endoscopic appearance.
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    Colorectal EMR outcomes in octogenarians versus younger patients referred for removal of large (≥20 mm) nonpedunculated polyps
    (Elsevier, 2021-03) Lee, Christopher J.; Vemulapalli, Krishna C.; Rex, Douglas K.; Medicine, School of Medicine
    Background and Aims Data are limited on safety and outcomes of colorectal EMR in octogenarians (≥80 years old). We sought to review outcome data for patients aged ≥80 in a prospectively collected database of patients referred for large polyp removal. Methods We retrospectively evaluated a database of patients referred for large (≥20 mm) nonpedunculated polyp removal. From 2000 to 2019, we compared the rates of follow-up, recurrence, adverse events, and synchronous neoplasia detection between younger patients and patients aged ≥80. Results There were 167 patients aged ≥80 years and 1686 <80 years. Patients in the elderly group returned for surveillance less often (67.1% vs 75.1%, P = .024), had greater first follow-up recurrence rates (27.5% vs 13.8%, P < .001), but had similar adverse event rates (1.8% vs 2.8%, P = .619) compared with younger patients. Rates of synchronous neoplasia were similar and high in both groups. Conclusions EMR is safe and well tolerated for large polyp removal in patients over 80 years old. Patients aged ≥80 years are less likely to present for follow-up after EMR. They had a higher recurrence rate and a similarly high prevalence of synchronous precancerous lesions. Follow-up after EMR should be encouraged in the elderly, and an attempt to clear the colon of synchronous disease at the time of the initial EMR may be warranted.
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    Defining conventional EMR in 2021: A burning issue
    (American Gastroenterological Association, 2021) Shahidi, Neal; Rex, Douglas K.; Medicine, School of Medicine
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    Prophylactic Clip Closure Clarified: The Question Is Not Whether to Clip, But When
    (Elsevier, 2019-11) Rex, Douglas K.; Medicine, School of Medicine
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    A Rare Cause of Dysphagia
    (Elsevier, 2020) Fatima, Hala; Wajid, Maryiam; Cummings, Oscar W.; Medicine, School of Medicine
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    Recurrence rates after EMR of large sessile serrated polyps
    (Elsevier, 2015-09) Rex, Kevin D.; Vemulapalli, Krishna C.; Rex, Douglas K.; Department of Medicine, School of Medicine
    Background Little is known regarding the recurrence rate after EMR of large (≥20 mm) sessile serrated adenoma/polyps (SSA/Ps). Objective To compare the recurrence rate among SSA/Ps and conventional adenomas in patients referred to a specialty practice for EMR. Design Retrospective cohort study. Setting Academic hospital and a satellite surgery center. Patients A total of 362 consecutive patients referred for resection of large (≥20 mm) polyps in the colorectum. Interventions All EMRs were performed with a submucosal contrast agent. All subjects had a follow-up surveillance examination (inspection and biopsy of the EMR) at our center. Main Outcome Measurements Rates of residual polyp at follow-up examination. Results Residual polyp was identified among 8.7% of SSA/Ps compared with 11.1% for conventional adenomas (P = .8). Limitations Retrospective design, procedures performed by a single experienced endoscopist, low number of serrated lesions. Conclusions The rate of recurrence after EMR of SSA/Ps is similar to the rate after EMR of conventional adenomas.
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    Routine Prophylactic Clip Closure is Cost Saving After Endoscopic Resection of Large Colon Polyps in a Medicare Population: Budget impact analysis: clip closure after resecting large colon polyps
    (Elsevier, 2019) Shah, Eric D.; Pohl, Heiko; Rex, Douglas K.; Morales, Shannon J.; Feagins, Linda A.; Law, Ryan; Medicine, School of Medicine
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    Safety and efficacy of hot avulsion as an adjunct to endoscopic mucosal resection (with videos)
    (Elsevier, 2019) Kumar, Vinod; Broadley, Heather; Rex, Douglas K.; Medicine, School of Medicine
    Background Excision of all visible neoplastic tissue is the goal of endoscopic mucosal resection (EMR) of colorectal laterally spreading tumors (LSTs). Flat and fibrotic tissue can resist snaring. Ablation of visible polyps is associated with high recurrence rates. Avulsion is a technique to continue resection when snaring fails. Methods We retrospectively analyzed colonic EMRs of 564 consecutive referred polyps between 2015 and 2017. Hot avulsion was used when snaring was unsuccessful. Polyps treated with and without avulsion were compared. Results Hot avulsion was used in 20.9% (n=112) of all resected lesions. The recurrence rates on follow up colonoscopy were 17.52% in avulsion group versus 16.02% in the non-avulsion group (p= 0.76). Hot avulsion was associated with a trend toward higher rates of delayed hemorrhage (5.35% vs 2.58%; p=0.15) and post-coagulation syndrome (1.8% vs 0.47%; p=0.15), but polyps treated with any avulsion were larger than those in which no avulsion was used (p=<0.001). There were an insufficient number of adverse events to perform a multivariable analysis testing the effects of avulsion, size, and location on the risk of overall adverse events. Conclusion Unlike previous reports of using argon plasma coagulation to treat visible polyp during EMR, hot avulsion of visible/fibrotic neoplasia was associated with similar EMR efficacy compared with cases that did not require hot avulsion. The safety profile of hot avulsion appears acceptable.
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    Safety of first surveillance colonoscopy at 12 months after piecemeal EMR of large nonpedunculated colorectal lesions
    (Elsevier, 2024-05) Bobay, Michael C.; Lahr, Rachel E.; Schultz, Jeremiah; Vemulapalli, Krishna C.; Guardiola, John J.; Rex, Douglas K.; Medicine, School of Medicine
    Background and Aims After piecemeal EMR (pEMR) of nonpedunculated colorectal lesions ≥20 mm, guidelines recommend first endoscopic surveillance at 6 months. However, initial surveillance at 12 months may be adequate for selected low-risk lesions and could save the cost, risk, and inconvenience of 1 surveillance examination. Methods This study retrospectively examined a prospectively collected database of all colorectal lesions referred to our center for endoscopic resection between August 2019 and April 2023. We report recurrence rates of patients with colorectal lesions ≥20 mm removed by pEMR who were assigned to 6-month first surveillance or to 12-month first surveillance (or assigned to a 6-month surveillance visit but did not return until after 10 months). Results There were 561 nonpedunculated lesions ≥20 mm that underwent first follow-up, including 490 lesions in 443 patients assigned to 6-month surveillance and 71 lesions in 65 patients assigned to 12-month surveillance. Lesions assigned to 12-month surveillance were smaller (mean size, 25.9 ± 6.1 mm vs 37.0 ± 17.4 mm), more likely serrated (63.4% vs 9.6%), and more often removed by cold pEMR (74.6% vs 20.4%). Twenty-nine lesions in 24 patients assigned to 6-month surveillance presented after 10 months, and their recurrence data were included in the group assigned to 12-month surveillance. Overall recurrence rates at 6 months and 12 months were 10.0% (46 of 461) and 10.0% (10 of 100), respectively. Mean recurrence sizes at 6 and 12 months were 10.9 ± 6.2 mm and 5.0 ± 3.1 mm, respectively. One patient in the 6-month surveillance group had cancer at the pEMR site, but no other recurrences at 6 or 12 months had either cancer or high-grade dysplasia. Conclusions Twelve-month surveillance seems acceptable for selected colorectal lesions ≥20 mm removed by pEMR. A randomized trial comparing initial 6-month versus 12-month surveillance is warranted for selected lesions.