title: Snare tip soft coagulation achieves effective and safe endoscopic hemostasis during wide-field endoscopic resection of large colonic lesions (with videos).
abstract: BACKGROUND
  Wide-field EMR (WF-EMR) of large colonic lesions exposes submucosal vessels, which may result in intraprocedural bleeding (IPB). Ongoing bleeding may obscure the endoscopic field, prolonging the procedure and reducing safety and accuracy. A number of potential interventions to control bleeding exist; however, they have inherent limitations. Safe, readily applicable, inexpensive, and effective therapy to control EMR-IPB has not yet been described.
  
  
  OBJECTIVE
  To evaluate the safety and efficacy of the snare tip soft coagulation (STSC) technique to control IPB after WF-EMR of large colonic lesions.
  
  
  METHODS
  Single-center, prospective cohort study.
  
  
  METHODS
  Tertiary care referral center.
  
  
  METHODS
  A total of 196 patients undergoing wide-field colonic EMR for flat and sessile lesions 20 mm or larger.
  
  
  METHODS
  A standard inject-and-resect EMR technique was applied. IPB was defined as bleeding obscuring the endoscopic field that persisted for 60 seconds or longer. STSC was performed by using the tip of the polypectomy snare to apply soft coagulation (80 W) to sites of IPB.
  
  
  METHODS
  Immediate hemostasis, postprocedural bleeding, and other adverse events.
  
  
  RESULTS
  A total of 198 lesions (mean size 41.5 mm, 64% in the right colon) were removed in 196 patients (mean age 68 years, 52.5% male). STSC alone achieved effective hemostasis in 40 of 44 cases of IPB (91%). In the remaining 4 cases, additional treatment with coagulating forceps or clips was required to achieve hemostasis. There were no immediate STSC-related adverse events. There was no statistically significant difference between the IPB and non-IPB groups in relation to the use of antiplatelet (P = .2) or anticoagulation agents (P = .4), postprocedural bleeding (P = .8) and adverse event rates (P = .7).
  
  
  CONCLUSIONS
  Nonrandomized study.
  
  
  CONCLUSIONS
  STSC is a simple and efficient first-line technique for achieving hemostasis of IPB during WF-EMR in the colon. It succeeds in the majority of cases and appears to be safe.
authors.affiliation: Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, Sydney, New South Wales, Australia.
authors.forename: Farzan
authors.initials: F
authors.lastname: Fahrtash-Bahin
authors.forename: Bronte A
authors.initials: BA
authors.lastname: Holt
authors.forename: Vanoo
authors.initials: V
authors.lastname: Jayasekeran
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Williams
authors.forename: Rebecca
authors.initials: R
authors.lastname: Sonson
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bourke
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000517:prevention & control; D015331:Cohort Studies; D003110:Colonic Neoplasms / Q000473:pathology / Q000601:surgery*; D003113:Colonoscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D016558:Hemostasis, Endoscopic / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014741:Video Recording; D055815:Young Adult