Insulated-tip knife endoscopic mucosal resection of large colorectal polyps unsuitable for standard polypectomy

Alessandro Repici, Massimo Conio, Claudio De Angelis, Anna Sapino, Alberto Malesci, Alberto Arezzo, Cristina Hervoso, Rinaldo Pellicano, Salvatore Comunale, Mario Rizzetto

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

OBJECTIVES: Endoscopic mucosal resection (EMR) has been shown to be safe and effective. En bloc resection is often not achieved using conventional EMR. Insulated-tip knife (It-knife) EMR has been recently proposed for early gastric cancer dissection and removal. This study was conducted to evaluate the safety and efficacy in obtaining en bloc resection with It-knife EMR of large colonic lesions not resectable with standard endoscopic techniques. METHODS: A total of 29 patients (19 men, 10 women, mean age 67.5 yr, range 44-88) were included in the study. Lesions were considered not suitable for standard polypectomy because of large diameter (>3cm), morphology, and/or position. Lesions were located in the rectum (N = 11), sigmoid: (N = 10), descending: (N = 4), transverse: (N = 2), and hepatic flexure (N = 2). After saline injection, circumferential incision and dissection of the lesions were attempted with the aim of achieving en bloc resection. RESULTS: En bloc resection was achieved in only 55.1% of the lesions (16 out of 29 patients). In the remaining cases, resection was completed with a piecemeal technique. The median size of the en bloc resected specimen was 3 x 3.4 cm. Complications occurred in four patients (13.7%). At histopathology, 13 patients had low-grade dysplasia, 15 high-grade dysplasia. One patient had a tumor invading the submucosa and was submitted to surgery. CONCLUSIONS: It-knife EMR is a promising technique for attempting en bloc resection of large colonic polyps. Adequate training and caution are required because it can be associated with a higher complication rate than with other EMR modalities.

Original languageEnglish
Pages (from-to)1617-1623
Number of pages7
JournalAmerican Journal of Gastroenterology
Volume102
Issue number8
DOIs
Publication statusPublished - Aug 2007

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Polyps
Dissection
Colonic Polyps
Sigmoid Colon
Rectum
Stomach Neoplasms
Endoscopic Mucosal Resection
Safety
Injections
Liver
Neoplasms

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Insulated-tip knife endoscopic mucosal resection of large colorectal polyps unsuitable for standard polypectomy. / Repici, Alessandro; Conio, Massimo; De Angelis, Claudio; Sapino, Anna; Malesci, Alberto; Arezzo, Alberto; Hervoso, Cristina; Pellicano, Rinaldo; Comunale, Salvatore; Rizzetto, Mario.

In: American Journal of Gastroenterology, Vol. 102, No. 8, 08.2007, p. 1617-1623.

Research output: Contribution to journalArticle

Repici, Alessandro ; Conio, Massimo ; De Angelis, Claudio ; Sapino, Anna ; Malesci, Alberto ; Arezzo, Alberto ; Hervoso, Cristina ; Pellicano, Rinaldo ; Comunale, Salvatore ; Rizzetto, Mario. / Insulated-tip knife endoscopic mucosal resection of large colorectal polyps unsuitable for standard polypectomy. In: American Journal of Gastroenterology. 2007 ; Vol. 102, No. 8. pp. 1617-1623.
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abstract = "OBJECTIVES: Endoscopic mucosal resection (EMR) has been shown to be safe and effective. En bloc resection is often not achieved using conventional EMR. Insulated-tip knife (It-knife) EMR has been recently proposed for early gastric cancer dissection and removal. This study was conducted to evaluate the safety and efficacy in obtaining en bloc resection with It-knife EMR of large colonic lesions not resectable with standard endoscopic techniques. METHODS: A total of 29 patients (19 men, 10 women, mean age 67.5 yr, range 44-88) were included in the study. Lesions were considered not suitable for standard polypectomy because of large diameter (>3cm), morphology, and/or position. Lesions were located in the rectum (N = 11), sigmoid: (N = 10), descending: (N = 4), transverse: (N = 2), and hepatic flexure (N = 2). After saline injection, circumferential incision and dissection of the lesions were attempted with the aim of achieving en bloc resection. RESULTS: En bloc resection was achieved in only 55.1{\%} of the lesions (16 out of 29 patients). In the remaining cases, resection was completed with a piecemeal technique. The median size of the en bloc resected specimen was 3 x 3.4 cm. Complications occurred in four patients (13.7{\%}). At histopathology, 13 patients had low-grade dysplasia, 15 high-grade dysplasia. One patient had a tumor invading the submucosa and was submitted to surgery. CONCLUSIONS: It-knife EMR is a promising technique for attempting en bloc resection of large colonic polyps. Adequate training and caution are required because it can be associated with a higher complication rate than with other EMR modalities.",
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AU - Repici, Alessandro

AU - Conio, Massimo

AU - De Angelis, Claudio

AU - Sapino, Anna

AU - Malesci, Alberto

AU - Arezzo, Alberto

AU - Hervoso, Cristina

AU - Pellicano, Rinaldo

AU - Comunale, Salvatore

AU - Rizzetto, Mario

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N2 - OBJECTIVES: Endoscopic mucosal resection (EMR) has been shown to be safe and effective. En bloc resection is often not achieved using conventional EMR. Insulated-tip knife (It-knife) EMR has been recently proposed for early gastric cancer dissection and removal. This study was conducted to evaluate the safety and efficacy in obtaining en bloc resection with It-knife EMR of large colonic lesions not resectable with standard endoscopic techniques. METHODS: A total of 29 patients (19 men, 10 women, mean age 67.5 yr, range 44-88) were included in the study. Lesions were considered not suitable for standard polypectomy because of large diameter (>3cm), morphology, and/or position. Lesions were located in the rectum (N = 11), sigmoid: (N = 10), descending: (N = 4), transverse: (N = 2), and hepatic flexure (N = 2). After saline injection, circumferential incision and dissection of the lesions were attempted with the aim of achieving en bloc resection. RESULTS: En bloc resection was achieved in only 55.1% of the lesions (16 out of 29 patients). In the remaining cases, resection was completed with a piecemeal technique. The median size of the en bloc resected specimen was 3 x 3.4 cm. Complications occurred in four patients (13.7%). At histopathology, 13 patients had low-grade dysplasia, 15 high-grade dysplasia. One patient had a tumor invading the submucosa and was submitted to surgery. CONCLUSIONS: It-knife EMR is a promising technique for attempting en bloc resection of large colonic polyps. Adequate training and caution are required because it can be associated with a higher complication rate than with other EMR modalities.

AB - OBJECTIVES: Endoscopic mucosal resection (EMR) has been shown to be safe and effective. En bloc resection is often not achieved using conventional EMR. Insulated-tip knife (It-knife) EMR has been recently proposed for early gastric cancer dissection and removal. This study was conducted to evaluate the safety and efficacy in obtaining en bloc resection with It-knife EMR of large colonic lesions not resectable with standard endoscopic techniques. METHODS: A total of 29 patients (19 men, 10 women, mean age 67.5 yr, range 44-88) were included in the study. Lesions were considered not suitable for standard polypectomy because of large diameter (>3cm), morphology, and/or position. Lesions were located in the rectum (N = 11), sigmoid: (N = 10), descending: (N = 4), transverse: (N = 2), and hepatic flexure (N = 2). After saline injection, circumferential incision and dissection of the lesions were attempted with the aim of achieving en bloc resection. RESULTS: En bloc resection was achieved in only 55.1% of the lesions (16 out of 29 patients). In the remaining cases, resection was completed with a piecemeal technique. The median size of the en bloc resected specimen was 3 x 3.4 cm. Complications occurred in four patients (13.7%). At histopathology, 13 patients had low-grade dysplasia, 15 high-grade dysplasia. One patient had a tumor invading the submucosa and was submitted to surgery. CONCLUSIONS: It-knife EMR is a promising technique for attempting en bloc resection of large colonic polyps. Adequate training and caution are required because it can be associated with a higher complication rate than with other EMR modalities.

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