Traction-assisted endoscopic mucosal resection for polypectomy in the large intestine

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Colorectal Cancer Prevention

Background:

• Colorectal adenomas require effective endoscopic resection.
• En bloc resection is preferred for complete removal and margin assessment.
• Difficult-to-access lesions pose a challenge for conventional techniques.

Purpose of the Study:

• To assess the feasibility of traction-assisted endoscopic mucosal resection (TA-EMR).
• To determine if TA-EMR enables en bloc resection of colorectal lesions.
• To evaluate TA-EMR's effectiveness in improving visualization of lesions.

Main Methods:

• Prospective enrollment of seven patients with 12 colorectal adenomas.
• Application of a hemostatic clip and suture for lesion traction via the colonoscope working channel.
• Resection of lesions using a conventional polypectomy snare mounted over the suture.

Main Results:

• Successful en bloc resection of all 12 lesions (including nine sessile adenomas).
• Achieved free lateral and vertical margins for all resected specimens.
• Improved visualization and resection in five lesions located in less-accessible areas.
• Mean lesion size was 9 mm and specimen size was 11 mm.
• No serious procedure-related complications were reported.

Conclusions:

• Traction-assisted endoscopic mucosal resection (TA-EMR) is technically feasible for colorectal lesions.
• The technique, utilizing a hemostatic clip and suture, facilitates en bloc resection.
• TA-EMR enhances visualization, particularly for lesions in challenging locations.