Commentary

Bleeding and recurrence are the primary concerns following endoscopic mucosal resection (EMR). Snare-tip soft coagulation has been employed to prevent both, with a particular emphasis on recurrence prevention and also on management of intraprocedural bleeding [1] [2] [3].

The innovation presented by Capogreco et al. lies in the use of high-voltage current (ForcedCOAG E4.0, ERBE VIO3, ERBE Elektromedizin, Tübingen, Germany) in combination with saline immersion. The high-voltage current enables efficient vessel coagulation, while the saline immersion minimizes deep thermal injury.

Moreover, this approach is cost-effective, as it reduces the need for hemostatic forceps, and time-saving by eliminating the necessity for device exchanges, simplifying the procedure overall.

While we may question the need to treat uncut and intact visible vessels, this novel technique offers an effective strategy for managing intraprocedural bleeding and could also potentially be used for ablation of margins or residual tissue in the mucosal defect.

Publication History

Article published online:
28 November 2024

• References

• 1 Fahrtash-Bahin F, Holt BA, Jayasekeran V. et al. Snare tip soft coagulation achieves effective and safe endoscopic hemostasis during wide-field endoscopic resection of large colonic lesions (with videos). Gastrointest Endosc 2013; 78: 158-163
• 2 Ferlitsch M, Moss A, Hassan C. et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2017; 49: 270-297
• 3 Albéniz E, Montori S, Rodríguez De Santiago E. et al. Preventing postendoscopic mucosal resection bleeding of large nonpedunculated colorectal lesions. Am J Gastroenterol 2022; 117: 1080-1088