title: Simple and reliable treatment for post-EMR artificial ulcer floor with snare cauterization for 10- to 20-mm colorectal polyps: a randomized prospective study (with video).
abstract: BACKGROUND
  Comparative studies on wound surface treatments after endoscopic mucosal resection (EMR) of 10- to 20-mm colorectal polyps have not been reported. We conducted a prospective trial of postoperative hemorrhage prevention measures after EMR of such polyps.
  
  
  METHODS
  Of 138 patients (397 polyps) who had undergone EMR, 62 patients (148 polyps) with 10- to 20-mm colorectal polyps were enrolled. Using the sealed envelope method, the subjects were randomly assigned to either a snare cauterization (75 polyps) or clip closure group (73 polyps). The primary assessment item was the wound surface treatment time (from immediately after polyp resection to wound surface treatment completion). The secondary assessment items were the incidence of delayed bleeding, perforation incidence 1-7 days after EMR, and difference in medical costs between the groups (University Hospital Medical Information Network: No. 000013473).
  
  
  RESULTS
  The time required for wound surface treatment completion was 3.26 ± 1.57 min in the snare cauterization group and 12.7 ± 2.92 min in the clip closure group, thus demonstrating a significant difference (P = 0.0001). Delayed bleeding was observed in two patients in the clip group, but was not observed in the snare cauterization group (P = 0.098). The clip group required the use of 720 clips that cost \523,410, US $5,163.50, or <euro>3,665.5.
  
  
  CONCLUSIONS
  After EMR of with 10- to 20-mm colorectal polyps, snare cauterization was superior to clip closure in terms of procedure time, and medical costs, and not inferior to clip closure in terms of the preventing effect of delayed bleeding.
authors.affiliation: Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Kita-gun, Miki-cho, Kagawa, 761-0793, Japan, hiro4884@med.kagawa-u.ac.jp.
authors.forename: Hirohito
authors.initials: H
authors.lastname: Mori
authors.forename: Hideki
authors.initials: H
authors.lastname: Kobara
authors.forename: Noriko
authors.initials: N
authors.lastname: Nishiyama
authors.forename: Shintaro
authors.initials: S
authors.lastname: Fujihara
authors.forename: Tae
authors.initials: T
authors.lastname: Matsunaga
authors.forename: Maki
authors.initials: M
authors.lastname: Ayaki
authors.forename: Taiga
authors.initials: T
authors.lastname: Chiyo
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Masaki
mesh_terms: D002425:Cautery / Q000379:methods*; D003111:Colonic Polyps / Q000473:pathology / Q000601:surgery*; D003113:Colonoscopy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D011446:Prospective Studies; D013525:Surgical Instruments; D016896:Treatment Outcome; D058106:Wound Closure Techniques / Q000295:instrumentation