John M. Levenick , Andrew J. Groff , Carl Manzo , Courtney Lester , Jennifer L. Maranki
{"title":"混合型APC结肠EMR,一种减少局部复发的新方法","authors":"John M. Levenick , Andrew J. Groff , Carl Manzo , Courtney Lester , Jennifer L. Maranki","doi":"10.1016/j.tige.2021.08.004","DOIUrl":null,"url":null,"abstract":"<div><h3>Background and Aims</h3><p>Endoscopic mucosal resection (EMR) has become the standard for removing large colon polyps but has a 10%-30% recurrence rate using standard techniques. Data shows improved recurrence rates with focal therapy of the edge of the resection base using cautery. We examine a novel technique, hybrid APC assisted EMR, which treats both the edge and the base with cautery to assess its effect on local recurrence.</p></div><div><h3>Methods</h3><p>We reviewed all EMRs of polyps >2 cm by a single endoscopist with 6-month follow-up from May 2018 to November 2019 using both standard EMR as well as hybrid APC assisted EMR to assess local recurrence as well adverse events.</p></div><div><h3>Results</h3><p>Forty-eight patients with 59 polyps removed by EMR had full 6 month follow up with a mean age of 66.1 years of age, 45% were female. Thirty polyps were removed by hybrid APC assisted EMR and 29 removed with standard EMR. Overall, 0 (0%) polyps in the h-APC arm had local recurrence while 6 (20.7%) in the standard group had histological proven local recurrence (<em>P</em> = 0.01). Postresection bleeding occurred in 6 patients, 2 in the hAPC arm and 4 in the standard arm (<em>P</em> = 0.41).</p></div><div><h3>Conclusion</h3><p>In this retrospective pilot study, hybrid APC assisted EMR was superior to conventional EMR for local recurrence after removal of large colon polyps and trended towards a less post-EMR bleeds.</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":null,"pages":null},"PeriodicalIF":1.2000,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.tige.2021.08.004","citationCount":"2","resultStr":"{\"title\":\"Hybrid APC Colon EMR, A Novel Approach to Reduce Local Recurrence\",\"authors\":\"John M. Levenick , Andrew J. Groff , Carl Manzo , Courtney Lester , Jennifer L. Maranki\",\"doi\":\"10.1016/j.tige.2021.08.004\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background and Aims</h3><p>Endoscopic mucosal resection (EMR) has become the standard for removing large colon polyps but has a 10%-30% recurrence rate using standard techniques. Data shows improved recurrence rates with focal therapy of the edge of the resection base using cautery. We examine a novel technique, hybrid APC assisted EMR, which treats both the edge and the base with cautery to assess its effect on local recurrence.</p></div><div><h3>Methods</h3><p>We reviewed all EMRs of polyps >2 cm by a single endoscopist with 6-month follow-up from May 2018 to November 2019 using both standard EMR as well as hybrid APC assisted EMR to assess local recurrence as well adverse events.</p></div><div><h3>Results</h3><p>Forty-eight patients with 59 polyps removed by EMR had full 6 month follow up with a mean age of 66.1 years of age, 45% were female. Thirty polyps were removed by hybrid APC assisted EMR and 29 removed with standard EMR. Overall, 0 (0%) polyps in the h-APC arm had local recurrence while 6 (20.7%) in the standard group had histological proven local recurrence (<em>P</em> = 0.01). Postresection bleeding occurred in 6 patients, 2 in the hAPC arm and 4 in the standard arm (<em>P</em> = 0.41).</p></div><div><h3>Conclusion</h3><p>In this retrospective pilot study, hybrid APC assisted EMR was superior to conventional EMR for local recurrence after removal of large colon polyps and trended towards a less post-EMR bleeds.</p></div>\",\"PeriodicalId\":36169,\"journal\":{\"name\":\"Techniques and Innovations in Gastrointestinal Endoscopy\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.2000,\"publicationDate\":\"2022-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1016/j.tige.2021.08.004\",\"citationCount\":\"2\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Techniques and Innovations in Gastrointestinal Endoscopy\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2590030721000647\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Techniques and Innovations in Gastrointestinal Endoscopy","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2590030721000647","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
Hybrid APC Colon EMR, A Novel Approach to Reduce Local Recurrence
Background and Aims
Endoscopic mucosal resection (EMR) has become the standard for removing large colon polyps but has a 10%-30% recurrence rate using standard techniques. Data shows improved recurrence rates with focal therapy of the edge of the resection base using cautery. We examine a novel technique, hybrid APC assisted EMR, which treats both the edge and the base with cautery to assess its effect on local recurrence.
Methods
We reviewed all EMRs of polyps >2 cm by a single endoscopist with 6-month follow-up from May 2018 to November 2019 using both standard EMR as well as hybrid APC assisted EMR to assess local recurrence as well adverse events.
Results
Forty-eight patients with 59 polyps removed by EMR had full 6 month follow up with a mean age of 66.1 years of age, 45% were female. Thirty polyps were removed by hybrid APC assisted EMR and 29 removed with standard EMR. Overall, 0 (0%) polyps in the h-APC arm had local recurrence while 6 (20.7%) in the standard group had histological proven local recurrence (P = 0.01). Postresection bleeding occurred in 6 patients, 2 in the hAPC arm and 4 in the standard arm (P = 0.41).
Conclusion
In this retrospective pilot study, hybrid APC assisted EMR was superior to conventional EMR for local recurrence after removal of large colon polyps and trended towards a less post-EMR bleeds.