MANAGEMENT OF SCARRED POLYPS: THE USE OF A NOVEL NON-DIATHERMIC ENDOSCOPIC MUCOSAL RESECTION DEVICE

Background:

Benign colonic polyps are traditionally resected via endoscopic mucosal resection (EMR). This technique is safe but carries risk of recurrence of 10 – 15% in polyps larger than 20 mm. Post-EMR recurrences are often scarred making endoscopic management of these polyps challenging with a high risk of complications. EndoRotor is a novel non-diathermic EMR device designed to reduce diathermy related complications (eg. perforation and delayed bleeding). We present a video demonstrating the use of this device in the management of scarred polyps.

Methods:

The non-diathermic device contains a fixed outer cannula and a rotating inner cannula with openings at the end of both cannulas. Polyp tissue is sucked into the openings and dissected without diathermy by the rotating inner cannula. The dissected tissue is transported into a tissue trap as the polyp is resected.

Results:

Two cases are shown to demonstrate the device. In Case 1, a 55-year-old female who previously underwent multi-piece EMR for a 50 mm LST-G in the recto-sigmoid junction, had a 10 mm residual tissue overlying a scarred resection base. Lifting solution consisting of gelofusine, indigo carmine and adrenaline was injected around the polyp. Due to scarring, no lift was obtained. EndoRotor was used to successfully resect the polyp without the need for diathermy. In the Case 2, an 81-year-old man who had previously undergone multipiece EMR of a hemi-circumferential LST-G in the recto-sigmoid junction. There was residual polyp on a scarred base that was treated with EndoRotor as in Case 1.

Conclusion:

Scarred polyps are challenging to manage endoscopically as the submucosal plane is lost due to fibrosis. This heightens the risk of perforation and delayed bleeding. EndoRotor is a novel device that is able to resect scarred polyps without the use of diathermy.