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Related Concept Videos

Endoscopic Procedures II: Colonoscopy01:25

Endoscopic Procedures II: Colonoscopy

41
The colon, or large intestine, is the final segment of the digestive system. Its primary functions include absorbing water and vitamins produced by gut bacteria and transforming waste from liquid to solid to form stool. In adults, the large intestine is approximately 5 feet long and consists of four main sections:
41
Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy01:26

Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy

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Sigmoidoscopy and laparoscopy are distinct medical procedures that enable physicians to internally inspect different parts of the GI tract. Although they serve different purposes, each is essential for diagnosing and, in some cases, treating various medical conditions.
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
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Endoscopic Procedures III: Video Capsule Endoscopy01:28

Endoscopic Procedures III: Video Capsule Endoscopy

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Capsule endoscopy, or wireless or video capsule endoscopy, is a diagnostic procedure for examining the entire gastrointestinal tract. Patients swallow a capsule about the size of a vitamin tablet. The capsule is equipped with a transmitter, a battery, an LED light source, and a color video camera to capture images throughout the gastrointestinal tract. This procedure is particularly useful for diagnosing conditions such as Crohn's disease, ulcerative colitis, tumors, polyps, ulcers,...
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Imaging Studies III: Gastrointestinal Motility Studies and Virtual Colonoscopy01:26

Imaging Studies III: Gastrointestinal Motility Studies and Virtual Colonoscopy

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This lesson explores three gastrointestinal imaging techniques: radionuclide testing, colonic transit studies, and virtual colonoscopy.
Radionuclide Testing
Radionuclide testing is a sophisticated medical technique for assessing gastrointestinal motility. It focuses on gastric emptying and colonic transit time. Radioactive markers track the movement of food through the digestive system, providing insights into gastrointestinal disorders.
In gastric emptying studies, a meal's liquid and...
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Endoscopic Procedures I: Esophagogastroduodenoscopy01:29

Endoscopic Procedures I: Esophagogastroduodenoscopy

46
An Esophagogastroduodenoscopy (EGD) is a diagnostic procedure in which an endoscopist uses a flexible, lighted endoscope to visualize the upper gastrointestinal (GI) tract. The procedure includes visualizing the oropharynx, esophagus, stomach, and the first part of the small intestine, the duodenum.
During an EGD, the endoscope can be used to:
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Endoscopic Procedures V: ERCP01:26

Endoscopic Procedures V: ERCP

51
Endoscopic Retrograde Cholangiopancreatography (ERCP) is a diagnostic procedure that combines endoscopy and fluoroscopy to diagnose and treat conditions related to the bile ducts, pancreatic ducts, and gallbladder. This procedure is beneficial for identifying and addressing blockages, gallstones, strictures, and tumors within the biliary or pancreatic systems. ERCP is both diagnostic and therapeutic, offering the ability to visualize and treat identified problems in one session.
Patient...
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Related Experiment Video

Updated: May 22, 2025

Clinical Application of Single-Surgeon, Three-Port, Laparoscopic Resection for Colorectal Cancer with Natural Orifice Specimen Extraction
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Cold snare endoscopic resection for large colon polyps: a randomised trial.

Heiko Pohl1,2, Douglas K Rex3, Jeremy Barber4

  • 1Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA heiko.pohl@dartmouth.edu.

Gut
|May 20, 2025
PubMed
Summary

Cold endoscopic mucosal resection (EMR) for large colorectal polyps did not significantly reduce severe adverse events but doubled polyp recurrence compared to hot EMR. Careful consideration of technique is needed for optimal outcomes.

Keywords:
COLONIC ADENOMASCOLONOSCOPYENDOSCOPIC POLYPECTOMYPostoperative Complications

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Area of Science:

  • Gastroenterology
  • Endoscopic Surgery
  • Colorectal Cancer Prevention

Background:

  • Complications associated with endoscopic mucosal resection (EMR) for large colorectal polyps are a significant clinical concern.
  • The use of electrocautery in EMR (hot EMR) versus cold EMR (without electrocautery) requires further safety and efficacy evaluation.

Purpose of the Study:

  • To compare the safety and efficacy of cold EMR versus hot EMR in the resection of large (≥20 mm) non-pedunculated colorectal polyps.
  • To evaluate severe adverse events (SAEs) and polyp recurrence rates between the two EMR techniques.

Main Methods:

  • A multicentre randomized trial involving 660 patients with large colorectal polyps.
  • Patients were assigned to either cold EMR or hot EMR as the primary intervention.
  • The study primarily analyzed the rates of severe adverse events and polyp recurrence.

Main Results:

  • Severe adverse events (SAEs) were observed in 2.1% of patients undergoing cold EMR versus 4.3% in the hot EMR group (p=0.10).
  • Per-protocol analysis showed significantly fewer SAEs with cold EMR (1.4% vs 5.0%, p=0.017), with zero perforations compared to 1.6% in hot EMR (p=0.028).
  • Polyp recurrence rates were significantly higher in the cold EMR group (27.6%) compared to the hot EMR group (13.6%, p<0.001).

Conclusions:

  • Universal application of cold EMR did not significantly lower severe adverse events unless the procedure could be completed successfully.
  • Cold EMR resulted in a doubled polyp recurrence rate compared to hot EMR.
  • The findings suggest that while cold EMR may offer safety benefits in specific scenarios, its higher recurrence rate necessitates careful consideration in clinical practice.