title: Hot avulsion: a modification of an existing technique for management of nonlifting areas of a polyp (with video).
abstract: BACKGROUND
  Endoscopic management of the nonlifting areas of a colonic polyp is a significant challenge. The traditional approach has been to use ablative techniques with mixed long-term results.
  
  
  OBJECTIVE
  To evaluate the safety and efficacy of hot avulsion (HA), a modification in the use of hot biopsy forceps in the management of the nonlifting areas of a colonic polyp.
  
  
  METHODS
  Retrospective review of data from a prospectively maintained colonic Endoscopic Mucosal Resection database.
  
  
  METHODS
  Tertiary referral hospital.
  
  
  METHODS
  Twenty patients in whom HA was used as part of the polypectomy technique.
  
  
  METHODS
  Location and size of polyp, reasons for nonlifting, immediate success, residual rates, and adverse events.
  
  
  RESULTS
  In our 20 patients studied, the main reasons for nonlifting were scarring from previous EMR attempts in 55% and scarring from previous biopsy in 35%. Mean size of avulsion was 4.4 mm (range, 1-15 mm). At the index procedure, HA was successful in removing macroscopic adenomatous tissue in all patients. At follow-up examinations, 85% (17/20) had no macroscopic or microscopic neoplasia residual and 15% (3/20) had a small area of residual that was easily treated with repeat HA. There were no immediate or long-term adverse events.
  
  
  CONCLUSIONS
  Nonrandomized, single-center experience.
  
  
  CONCLUSIONS
  HA appears to be a safe and effective adjunct treatment to snare polypectomy for nonlifting areas of a colonic polyp. Further randomized multicenter studies are required with direct comparison to established techniques.
authors: Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Perth, Western Australia.
authors: Sundaram G
authors: SG
authors: Veerappan
authors: Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Perth, Western Australia.
authors: Donald
authors: D
authors: Ormonde
authors: Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Perth, Western Australia.
authors: Ian F
authors: IF
authors: Yusoff
authors: Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Perth, Western Australia.
authors: Spiro C
authors: SC
authors: Raftopoulos
mesh_terms: D018256:Adenomatous Polyps / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000601:surgery*; D003111:Colonic Polyps / Q000601:surgery*; D003113:Colonoscopy / Q000379:methods*; D016208:Databases, Factual; D004210:Dissection / Q000379:methods; D004598:Electrosurgery / Q000379:methods*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies