title: Endoscopic mucosal resection for middle and large colorectal polyps with a double-loop snare.
abstract: OBJECTIVE
  This study aimed to analyze the endoscopic mucosal resection (EMR) with a novel uniquely shaped, double-loop snare (Dualoop, Medico's Hirata Inc., Tokyo, Japan) for colorectal polyps.
  
  
  METHODS
  This was a clinical trial conducted in two referral centers, Kyoto Prefectural University of Medicine and National Cancer Center Hospital in Japan. First, the firmness of various snares including 'Dualoop' was experimentally analyzed with a pressure gauge. Five hundred and eighty nine consecutive polyps that underwent EMR with 'Dualoop' were compared to 339 polyps with the standard round snare. Lesion characteristics, en bloc resection, and complications were analyzed.
  
  
  RESULTS
  'Dualoop' had the most firmness among the various snares. The average tumor size was 9.3 mm (5-30), and en bloc resection was achieved in 95.4%. The rate of en bloc resection for middle polyps 15-19 mm in diameter was significantly higher with the 'Dualoop' than that with the round snare (97.9 vs. 80.0%, p < 0.05). The rate of en bloc resection was 64.7% for large polyps ≥20 mm in diameter using 'Dualoop'. Higher age, larger tumor size, and superficial polyps were associated with the failure of en bloc resection.
  
  
  CONCLUSIONS
  EMR with 'Dualoop' was effective for resecting both middle and large polyps en-bloc.
authors.affiliation: Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan.
authors.forename: Naohisa
authors.initials: N
authors.lastname: Yoshida
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Saito
authors.forename: Ryohei
authors.initials: R
authors.lastname: Hirose
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Ogiso
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Inada
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Yagi
authors.forename: Yuji
authors.initials: Y
authors.lastname: Naito
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Otake
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakajima
authors.forename: Takahisa
authors.initials: T
authors.lastname: Matsuda
authors.forename: Akio
authors.initials: A
authors.lastname: Yanagisawa
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Itoh
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003111:Colonic Polyps / Q000601:surgery*; D003113:Colonoscopy / Q000295:instrumentation*; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D004210:Dissection; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology / Q000601:surgery; D007417:Intestinal Polyps / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D047368:Tumor Burden; D055815:Young Adult