title: Knife-assisted snare resection: a novel technique for resection of scarred polyps in the colon.
abstract: OBJECTIVE
  There have been significant advances in the management of complex colorectal polyps. Previous failed resection or polyp recurrence is associated with significant fibrosis, making endoscopic resection extremely challenging; the traditional approach to these lesions is surgery. The aim of this study was to evaluate the efficacy of a novel, knife-assisted snare resection (KAR) technique in the resection of scarred colonic polyps.
  
  
  METHODS
  This was a prospective cohort study of patients, in whom the KAR technique was used to resect scarred colonic polyps > 2  cm in size. Patients had previously undergone endoscopic mucosal resection (EMR) and developed recurrence, or EMR had been attempted but was aborted as a result of technical difficulty.
  
  
  RESULTS
  A total of 42 patients underwent KAR of large (median 40  mm) scarred polyps. Surgery for benign disease was avoided in 38 of 41 patients (93 %). No life-threatening complications occurred. Recurrence was seen in six patients (16 %), five of whom underwent further endoscopic resection. The overall cure rate for KAR in complex scarred colonic polyps was 90 %.
  
  
  CONCLUSIONS
  KAR of scarred colonic polyps by an expert endoscopist was an effective and safe technique with low recurrence rates.
authors.affiliation: Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, United Kingdom.
authors.forename: Fergus J Q
authors.initials: FJ
authors.lastname: Chedgy
authors.affiliation: Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, United Kingdom.
authors.forename: Rupam
authors.initials: R
authors.lastname: Bhattacharyya
authors.affiliation: Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, United Kingdom.
authors.forename: Kesavan
authors.initials: K
authors.lastname: Kandiah
authors.affiliation: Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, United Kingdom.
authors.forename: Gaius
authors.initials: G
authors.lastname: Longcroft-Wheaton
authors.affiliation: Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, United Kingdom.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Bhandari
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003111:Colonic Polyps / Q000473:pathology / Q000601:surgery*; D003113:Colonoscopy / Q000295:instrumentation / Q000379:methods*; D004210:Dissection / Q000295:instrumentation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation