title: A new accessory, endoscopic cuff, improves colonoscopic access for complex polyp resection and scar assessment in the sigmoid colon (with video).
abstract: BACKGROUND
  Difficult and unstable endoscopic access to large sessile/flat colon polyps in the sigmoid colon may prevent successful and complete EMR.
  
  
  OBJECTIVE
  We report our experience with the use of an endoscopic cuff, a new endoscopic accessory, to improve endoscopic access during endoscopic therapy and scar assessment.
  
  
  METHODS
  Single-center, retrospective, feasibility case series.
  
  
  METHODS
  Tertiary referral academic endoscopy unit.
  
  
  METHODS
  Nonconsecutive patients referred for endoscopic resection of large flat/sessile sigmoid colon polyps or surveillance of postpolypectomy scars in the sigmoid colon.
  
  
  METHODS
  When conventional methods to achieve stable access and visualization were unsuccessful, the endoscopic cuff was used to retract sigmoid colon folds.
  
  
  METHODS
  Safety, procedural success, and complications.
  
  
  RESULTS
  Five patients (mean age 62 years, 3 male/2 female) underwent endoscopic cuff-assisted EMR polypectomy, and 7 patients (mean age 62 years, 2 male/5 female) underwent post-EMR scar surveillance with an endoscopic cuff-assisted flexible sigmoidoscopy. All sessile/flat polyps (mean size 29 mm) or post-EMR scar sites (mean size 15 mm) were located at acute bends in the sigmoid colon. With the endoscopic cuff placed around the tip of the colonoscope, endoscopic access improved significantly by flattening/depressing colon folds close to the lesion/scar. The entire polyp/scar surface was revealed, facilitating a complete polyp excision and a meticulous scar assessment. No immediate or delayed adverse events were seen.
  
  
  CONCLUSIONS
  Single-center, nonrandomized case series.
  
  
  CONCLUSIONS
  An endoscopic cuff appears to be a safe and easily used accessory to facilitate colonoscopic access for complex polypectomy and scar assessment in the sigmoid colon.
authors.affiliation: Wolfson Unit for Endoscopy, St. Mark's Hospital and Academic Institute, London, United Kingdom. ztsiam@otenet.gr
authors.forename: Zacharias P
authors.initials: ZP
authors.lastname: Tsiamoulos
authors.forename: Brian P
authors.initials: BP
authors.lastname: Saunders
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002921:Cicatrix / Q000209:etiology / Q000473:pathology*; D003111:Colonic Polyps / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000473:pathology*; D012189:Retrospective Studies; D012811:Sigmoid Neoplasms / Q000473:pathology / Q000601:surgery*; D012812:Sigmoidoscopy / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome