Endoscopic mucosal resection using a pure cut and hemoclip method for colonic nonpolypoid neoplasms

Colonic mucosal neoplastic lesions can be classified morphologically into polypoid and nonpolypoid types. The nonpolypoid type has a greater malignancy potential than does the polypoid type. Removing these lesions and obtaining an integral specimen for histopathologic assessment during colonoscopy are very important. This study evaluates the safety and integrity of specimens obtained by endoscopic mucosal resection (EMR) using the pure cut current and hemoclip method.

Fourteen nonpolypoid colonic neoplasms, which were removed by EMR using the pure cut and hemoclip method between April 2001 and April 2002, were studied. There were 9 male and 4 female patients and the mean age was 57.8 +/- 15.5 (range, 32 - 80) years. EMR was conducted in cases where the lesions were diagnosed as neoplastic tumors by magnification colonoscopy and the indigo carmine dye spray method.

The study revealed 11 flat type neoplasms and 3 laterally spreading tumors. The mean size of the lesions was 10.7 +/- 5.6 (range, 6 - 25) mm. All lesions were completely removed. Histopathologically, there were 1 adenocarcinoma and 13 adenomas (3 with mild dysplasia, 7 with moderate dysplasia, and 3 with severe dysplasia). The mean number of hemoclips used was 2.14 +/- 0.66 (range, 1 - 3) pieces. No bleeding or perforation was noted following EMR.

EMR using the pure cut and hemoclip method is a useful means of obtaining an integral specimen for accurate pathologic assessment. This method provides a safe and minimally invasive technique for managing colonic non-polypoid lesions.