title: Endoscopic mucosal resection with the grasp-and-snare technique through a double-channel endoscope in humans.
abstract: BACKGROUND
  EMR is being used to manage premalignant lesions of the GI tract. Lifting of the lesion is required to perform EMR. Earlier biopsy or snare may cause scarring and preclude adequate lifting.
  
  
  OBJECTIVE
  We report our experience with a novel grasp-and-snare EMR technique that can be used when a good lifting is not achieved or the location of the lesion is challenging for standard EMR, such as in a fold.
  
  
  METHODS
  Single-center case series.
  
  
  METHODS
  Tertiary referral academic gastroenterology unit.
  
  
  METHODS
  Patients referred for endoscopic treatment of flat gastrointestinal polyps.
  
  
  METHODS
  Single-session EMR performed with a grasp-and-snare technique through a double-channel gastroscope or colonoscope.
  
  
  METHODS
  Technical success, complication rates, and recurrence rates.
  
  
  RESULTS
  Seventeen patients with flat gastrointestinal polyps were referred: mean age 70 years, 11 (65%) male, polyp size 0.8 to 6 cm; 13 colonic, 2 duodenal, 1 gastric, and 1 esophageal EMR performed with grasp-and-snare technique in single sessions. Six polyps (35%) did not lift after injection of hydroxypropylmethylcellulose. Fourteen polyps (82%) were resected completely. Two complications occurred (12%): 1 bleeding treated medically and 1 perforation treated surgically. Residual disease at 1 year was 18%, but 8 patients (47%) had not yet had their 1-year follow-up.
  
  
  CONCLUSIONS
  Single-center, uncontrolled, not randomized. Limited follow-up.
  
  
  CONCLUSIONS
  The grasp-and-snare technique can be used to perform EMR with good outcomes and low complication rates in areas where poor lifting and accessibility are problems.
authors.affiliation: Department of Internal Medicine, Mayo Clinic Florida, Jacksonville, FL 32224, USA.
authors.forename: Silvio W
authors.initials: SW
authors.lastname: de Melo
authors.forename: Patrick
authors.initials: P
authors.lastname: Cleveland
authors.forename: Massimo
authors.initials: M
authors.lastname: Raimondo
authors.forename: Michael B
authors.initials: MB
authors.lastname: Wallace
authors.forename: Timothy
authors.initials: T
authors.lastname: Woodward
mesh_terms: D000368:Aged; D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery*; D007417:Intestinal Polyps / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome