P1184 - Soft Tip Coagulation and Partial Defect Closure in Endoscopic Mucosal Resection: A Tertiary Care Center Experience

Mira Alsheikh, MD¹, Jean Chalhoub, MD², Hassan Al Moussawi, MBBS¹, Youssef Eldouaihy, DM¹, Harika Kandlakunta, MD³, Dhineshreddy Gurala, MD¹, Sherif Andrawes, MD¹, Anum Aqsa, MD¹, Samragnyi Madala, MD^1
1Staten Island University Hospital, Staten Island, NY; ²University of Massachusetts Medical School, Springfield, MA; ³Staten Island University Hospital, Northwell Health, Staten Island, NY

Introduction: Around 10-15% of polyps found during screening colonoscopies are large and challenging to resect, requiring endoscopic mucosal resection (EMR). EMR for large ( >2 cm), flat, or laterally spreading tumors has become a standard of practice. However, the mucosal defects expose submucosal vessels to injury, resulting in intraprocedural bleeding (IPB) in around 12% of cases, delayed post-procedural bleeding (DPPB) in around 4%, and a perforation rate of around 1%.

Aims: Describe outcomes of large polyp piecemeal EMR followed by avulsion of non-bleeding vessels using snare tip soft coagulation in the resection bed along with edge clipping, and compare complication rates to those reported in the literature

Methods: This is a case series that includes prospectively and retrospectively collected data on adult patients who underwent EMR polypectomy for polyps ³ 2 cm in size at a single tertiary-care referral center. We describe the experience of a single endoscopist who performed all procedures with piecemeal EMR using a 2 cm hot snare, followed by avulsion of the remaining vessels using snare tip soft coagulation, and finally deploying clips at the edges. We performed descriptive statistics as well as single sample proportion comparison of complication rates with those reported in the literature

Results: 118 patients were included of which, 59 (57.3%) were males, 89 (86.6%) were Caucasians, and 34 (28.8%) were on an antithrombotic drug. In regards to procedure related outcomes, 76 (64.4 %) polyps were in the right colon, mean polyp size was 36.8 mm (± 20.6), 57 (48.3%) polyps measured ³ 40 mm, 60 (51.3%) appeared sessile, and 58 (49.2%) were tubular adenomas. An average of 2.5 clips were used per procedure. IPB was seen in 18 (15.3%), while 3 (2.5%) patients had DPPB, and 2 (1.7%) had perforation. When compared to the current literature, our data revealed no statistically significant difference in IPB rates (p=0.06), DPPB (p=0.67) and perforation rates (p=0.45).

Discussion: The complication rates of this novel EMR technique are similar to those reported in the literature. The limited use of endoclips at the defect edges only, has the potential to decrease healthcare costs associated with the higher number of endoclip needed for full defect closure. Larger RCTs and cost-analysis studies are needed to further explore those findings


Disclosures:


Mira Alsheikh, MD¹, Jean Chalhoub, MD², Hassan Al Moussawi, MBBS¹, Youssef Eldouaihy, DM¹, Harika Kandlakunta, MD³, Dhineshreddy Gurala, MD¹, Sherif Andrawes, MD¹, Anum Aqsa, MD¹, Samragnyi Madala, MD¹. P1184 - Soft Tip Coagulation and Partial Defect Closure in Endoscopic Mucosal Resection: A Tertiary Care Center Experience, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.