All procedures were performed this website by a single experienced endoscopist. The technique starts with submucosal (SM) injection followed by mucosal incision using a dual knife (Olympus KD-650L). This is followed by variable degrees of SM dissection and completion of circumferential mucosal incision.
Finally a snare-assisted resection is performed in an en-bloc or piecemeal fashion. Results: 170 polyps in 170 patients of mean age 71 years. Mean polyp size 46 mm (20–170 mm). 29% were >50 mm. 22% were scarred from previous attempted resection. En-bloc resection: 70/170 (41%). Size of polyp <50 mm was a significant (p < 0.001) predictor of en-bloc resection. The complication rate was 14/170 (8.2%) with 8 (4.7%) bleeds and 2 (1.2%) perforations. Complications were not linked to polyp size, scarring or resection site. A single patient with perforation required surgery. All other complications were managed endoscopically. The recurrence rate was 21/151 (13.9%). This was significantly higher for polyps >50 mm (p = 0.008) and in polyps with fibrosis (p = 0.002). We observed that from 2011 to 2013, the en-bloc resection rates in polyps 20–50 mm without fibrosis
steadily increased from year-to-year (33%–47%–77%). Demonstrating increasing experience did translate into improved en-bloc resection rates. Conclusion: This is the largest reported Western INK128 series on KAR in the colon. We have demonstrated feasibility, efficacy and safety of this technique for polyps of all sizes, with or without scarring; and at all sites. We have also identified significant outcome predictors and defined the learning curve. This can inform future standards of training and practice in the Western setting. Key Word(s): 1. Endoscopy; 2. colon; 3. ESD Table 1. Factors
predicting en bloc resection SIZE FIBROSIS SITE 20–50 mm >50 mm Yes No LC RC n = 120 n = 50 n = 37 n = 133 n = 127 n = 43 EN BLOC RESECTION 70/170(41%) 64/120 (53%) 6/50 (12%) 12/37 (32%) 58/133 (44%) 49/127 (39%) 21/43 (49%) P < 0.001 P < 0.107 P < 0.900 Table 2. Factors associated with recurrence SIZE FIBROSIS SITE RESECTION TYPE 20–50 mm the >50 mm yes no LC RC En bloc Piecemeal RECURRENCE 21/151 (13.9%) 9/112 (8%) 12/39 (31%) 9/30 (30%) 12/121 (10%) 18/112 (16%) 3/39 (7.7%) 3/66 (4.5%) 18/85 (21.2%) P = 0.008 P = 0.002 P = 0.319 P = 0.091 Presenting Author: FERGUS CHEDGY Additional Authors: G. LONGCROFT-WHEATON, P. BHANDARI Corresponding Author: FERGUS CHEDGY Affiliations: Queen Alexandria Hospital, Queen Alexandria Hospital Objective: Current standard of care for recurrent/residual polyps after previous endoscopic resection is surgery. This study analyses the outcomes of salvage endoscopic resection of polyps with severe scarring. Methods: Prospective cohort study of patients referred to a tertiary-centre for resection of scarred polyps with failed previous endoscopic resection attempts. Resection technique: ESD knife & Snare combination (KAR) or Snare & APC combination (SAR).