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Surgical margin-negative endoscopic mucosal resection with simple three-clipping technique: a randomized prospective
Hirohito Mori1,2, Hideki Kobara3, Noriko Nishiyama3
1Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan. hiro4884@med.kagawa-u.ac.jp.
Surgical Endoscopy
|February 24, 2016
Summary
Pre-clipping colorectal polyps to the muscularis propria improves resection quality. This technique reduces positive margins and thermal damage, enhancing treatment effectiveness for endoscopic mucosal resection.
Area of Science:
- Gastroenterology
- Endoscopic Surgery
- Colorectal Cancer Prevention
Background:
- Endoscopic mucosal resection (EMR) is a standard treatment for colorectal polyps.
- Local recurrence after EMR occurs in 13% of cases, often due to incomplete snaring.
- Inadequate resection margins and thermal damage are key challenges in EMR.
Purpose of the Study:
- To evaluate the efficacy of pre-clipping colorectal polyps to the muscularis propria.
- To determine if this technique improves resection margins and reduces thermal denaturation.
- To assess the impact of pre-clipping on specimen quality during EMR.
Main Methods:
- A randomized controlled trial involving 188 colorectal polyps from 81 patients.
- Polyps were allocated to conventional injection (CG) or pre-clipping injection (PG) groups.
- The PG involved three-point pre-clipping to the muscularis propria and local injection, with measurements via endoscopic ultrasonography.
Main Results:
- The pre-clipping group (PG) showed significantly fewer instances of thermal denaturation (HMX/VMX) and positive margins (HM+/VM+) compared to the conventional group (CG).
- The shortest distance from tumor margin to resected edge was significantly greater in the PG (4.7 mm) than in the CG (0.6 mm).
- Maximum bulge distances were also significantly larger in the PG (11.0 mm) versus the CG (4.6 mm), indicating better tissue elevation.
Conclusions:
- Pre-clipping colorectal polyps to the muscularis propria facilitates margin-negative resections.
- This technique effectively prevents thermal denaturation of surgical margins.
- Pre-clipping represents a significant advancement in improving EMR outcomes for colorectal polyps.
