Background
Difficult and unstable endoscopic access to large sessile/flat colon polyps in the
sigmoid colon may prevent successful and complete EMR.
Objective
We report our experience with the use of an endoscopic cuff, a new endoscopic accessory,
to improve endoscopic access during endoscopic therapy and scar assessment.
Design
Single-center, retrospective, feasibility case series.
Setting
Tertiary referral academic endoscopy unit.
Patients
Nonconsecutive patients referred for endoscopic resection of large flat/sessile sigmoid
colon polyps or surveillance of postpolypectomy scars in the sigmoid colon.
Interventions
When conventional methods to achieve stable access and visualization were unsuccessful,
the endoscopic cuff was used to retract sigmoid colon folds.
Main Outcome Measurements
Safety, procedural success, and complications.
Results
Five patients (mean age 62 years, 3 male/2 female) underwent endoscopic cuff–assisted
EMR polypectomy, and 7 patients (mean age 62 years, 2 male/5 female) underwent post-EMR
scar surveillance with an endoscopic cuff–assisted flexible sigmoidoscopy. All sessile/flat
polyps (mean size 29 mm) or post-EMR scar sites (mean size 15 mm) were located at
acute bends in the sigmoid colon. With the endoscopic cuff placed around the tip of
the colonoscope, endoscopic access improved significantly by flattening/depressing
colon folds close to the lesion/scar. The entire polyp/scar surface was revealed,
facilitating a complete polyp excision and a meticulous scar assessment. No immediate
or delayed adverse events were seen.
Limitations
Single-center, nonrandomized case series.
Conclusions
An endoscopic cuff appears to be a safe and easily used accessory to facilitate colonoscopic
access for complex polypectomy and scar assessment in the sigmoid colon.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Gastrointestinal EndoscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Polypectomy techniques for difficult colon polyps.Dig Dis. 2008; 26: 342-346
- Complex colon polypectomy.Gastroenterol Hepatol (NY). 2010; 6: 375-382
- Large refractory colon polyps: is it time to change our practice?.Gastrointest Endosc. 2009; 70: 1128-1136
- Efficacy of endoscopic mucosal resection with circumferential incision for patients with large colorectal tumors.Clin Gastroenterol Hepatol. 2012; 10: 22-26
- Colonoscopic polypectomy in retroflexion.Gastrointest Endosc. 2006; 63: 144-148
- Usefulness of a pediatric colonoscope for colonoscopy in adults.Gastrointest Endosc. 2000; 51: 314-317
- Impact of a transparent hood on the performance of total colonoscopy: a randomized controlled trial.Gastrointest Endosc. 2009; 69: 637-644
- Higher adenoma detection rates with cap-assisted colonoscopy: a randomised controlled trial.Gut. 2012; 61: 402-408
- Endoscopic mucosal resection of 161 cases of large sessile or flat colorectal polyps.Scand J Gastroenterol. 2007; 42: 859-866
- The Vienna classification of gastrointestinal epithelial neoplasia.Gut. 2000; 47: 251-255
- Diverticular disease and diverticulitis.Am J Gastroenterol. 2008; 103: 1550-1556
- CT colonography features of sigmoid diverticular disease.J Clin Imaging. 2005; 29: 200-206
- Effectiveness of radical surgery after incomplete endoscopic mucosal resection for early colorectal cancers: a clinical study investigating risk factors of residual cancer.Dig Dis Sci. 2008; 53: 2941-2946
- Outcome of laparoscopic colectomy for polyps not suitable for endoscopic resection.Surg Endosc. 2007; 21: 400-403
- Incidence and predictors of “late” recurrence after endoscopic piecemeal resection of large sessile adenomas.Gastrointest Endosc. 2009; 70: 344-349
- Endoscopic mucosal ablation (EMA): a new APC/injection technique to assist complete resection of recurrent, fibrotic colon polyps (with video).Gastrointest Endosc. 2012; 75: 400-404
- Cap-assisted endoscopic mucosal resection of large polyps involving the ileocecal valve.Endoscopy. 2010; 42: 677-680
- Usefulness of cap-assisted colonoscopy during colonoscopic EMR: a randomized, controlled trial.Gastrointest Endosc. 2011; 74: 869-875
Article info
Publication history
Accepted:
August 16,
2012
Received:
March 23,
2012
Footnotes
DISCLOSURE: The authors disclosed no financial relationships relevant to this publication.
If you would like to chat with an author of this article, you may contact Dr Tsiamoulos at [email protected]
Identification
Copyright
© 2012 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
