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Identifying the impossible: piecemeal cold snare resection perforation
Hyun Jae Kim1, Douglas Motomura1,2, Eric C S Lam1,2
1Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Summary
Piecemeal cold snare resection (CSR) for large colorectal polyps can rarely cause perforation. Meticulous assessment of the resection site is crucial, even without electrocautery, to identify potential deep mural injuries.
Area of Science:
- Gastroenterology
- Endoscopic Surgery
- Colorectal Cancer Prevention
Background:
- Piecemeal cold snare resection (CSR) is a common technique for large nonpedunculated colorectal polyps.
- While generally safe, CSR carries a rare risk of perforation.
- This case highlights an intraprocedural perforation during CSR.
Purpose of the Study:
- To report a rare case of intraprocedural perforation during piecemeal cold snare resection (CSR).
- To emphasize the importance of thorough resection base assessment in CSR procedures.
Main Methods:
- A 63-year-old woman with Crohn disease underwent surveillance for colorectal polyps.
- Piecemeal CSR was performed on two large 0-IIA transverse colon polyps using a 10-mm cold snare and chromoinjectate.
- Submucosal chromoendoscopy identified a deep mural injury, which was managed with through-the-scope clips.
Main Results:
- A type IV deep mural injury was identified during piecemeal CSR, despite the absence of electrocautery.
- The injury was successfully managed with endoscopic clipping.
- The patient recovered without delayed adverse events.
Conclusions:
- Perforation is a rare but possible complication of piecemeal cold snare resection (CSR).
- Endoscopists must conduct meticulous resection base assessments, as the lack of cautery can mask deep mural injuries.
- Early recognition and endoscopic management are key to favorable outcomes.
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