Endoscopy 2020; 52(S 01): S143
DOI: 10.1055/s-0040-1704441
ESGE Days 2020 ePoster Podium presentations
Thursday, April 23, 2020 11:00 – 11:30 ESD 2 ePoster Podium 7
© Georg Thieme Verlag KG Stuttgart · New York

ENDOSCOPIC SUBMUCOSAL DISSECTION USING SCISSOR-TYPE KNIFE (SB KNIFE JR) FOR LARGE BROAD-BASED OR STALKED COLONIC POLYPS: A MULTICENTRE CASE SERIES

A Dhillon
1   St Mark’s Hospital, Wolfson Unit for Endoscopy, London, United Kingdom
,
N Suzuki
1   St Mark’s Hospital, Wolfson Unit for Endoscopy, London, United Kingdom
,
R Rajaratnam
2   Hillingdon Hospitals NHS Foundation Trust, London, United Kingdom
3   Imperial College London, Department of Surgery and Cancer, London, United Kingdom
,
A Parra-Blanco
4   Nottingham University Hospitals NHS Trust, NIHR Nottingham Digestive Diseases Biomedical Research Centre, Nottingham, United Kingdom
,
A Latchford
1   St Mark’s Hospital, Wolfson Unit for Endoscopy, London, United Kingdom
3   Imperial College London, Department of Surgery and Cancer, London, United Kingdom
,
Y Shunsuke
5   Sahlgrenska University Hospital, Division of Gastroenterology, Department of Internal Medicine, Gothenburg, Sweden
,
A Ahmad
1   St Mark’s Hospital, Wolfson Unit for Endoscopy, London, United Kingdom
,
BP Saunders
1   St Mark’s Hospital, Wolfson Unit for Endoscopy, London, United Kingdom
3   Imperial College London, Department of Surgery and Cancer, London, United Kingdom
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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Aims Large, broad-based pedunculated (Ip) or sub-pedunculated (Isp) polyps can be technically difficult to resect with significant risk of intraprocedural and delayed bleeding. We report our experience in endoscopic submucosal dissection (ESD) using a scissor-type knife (SB-knife Junior, Sumius) for these lesions.

Methods Databases from four institutions including 57 consecutive patients with 61 polyps (Ip n=38/Isp n=23) resected by ESD with SB-knife between 2014 and 2019 were analysed. Intra-procedural bleeding was treated with the haemostatic function of SB-knife. Clinicopathological characteristics, additional instrument exchange for haemostasis and complication rates were examined.

Results Median polyp size was 35mm (20-70mm). Fifty-one polyps (84%) were in rectum/sigmoid colon. Histology showed: 30 adenomas with low-grade dysplasia (49%), 19 adenomas with high-grade dysplasia (31%), four T1N0 adenocarcinomas (7%), three serrated lesions (5%), three hamartomas (5%) and two lipomas (3%).

En-bloc resection was achieved for 57 polyps (95%). Three Isp lesions were switched to piecemeal snare-resection after partial SB-knife dissection. One ESD was abandoned due to muscle retraction during dissection. At surgery, this patient had a T1N0 (SM3) tumour.

Complete histological (R0) resection rate was 91% (52/57). Two cases had unevaluable margins (RX) and one case had deep margin involvement (R1). Of three polyp cancers, one had curative (R0) resection at index procedure with SB-knife whilst two patients at risk of lymph node metastasis underwent additional radical surgery.

Haemostatic forceps were required during in 11 ESD cases (18%). Prophylactic clips were used in 54 (89%) cases (median 4 clips (range 1-10). There were no episodes of perforation or post-polypectomy bleeding. Twenty-nine patients (51%) had endoscopic follow-up data over a median 12 months (range 6-48). One piecemeal resected polyp had local recurrence at 6 months, treated successfully with under-water EMR.

Conclusions ESD with the SB-knife is efficient and safe in treating Ip/Isp polyps. Our series highlighted a favourable short and medium-term outcome.