S-EMR: A first experience with stalked endoscopic mucosal resection in thick and high-risk pedunculated polyps

Post-polypectomy bleeding (PPB) is a relatively common event after polypectomy of large polyps using conventional methods, and the likelihood of malignant tissue remaining remains. The aim of this study was to investigate the efficacy of stalked endoscopic mucosal resection (S-EMR) as a potential solution to PPB in large pedunculated and semi-pedunculated colonic polyps and to reduce the need for repeat endoscopic intervention and surgery for malignant polyps.

This prospective, single-arm, open-label study was conducted on patients in whom screening colonoscopy was indicated. All patients who were found to have pedunculated and semi-pedunculated polyps (Paris class Ip and Ips) with a thick stalk (>10 mm), a polyp head ≥20 mm in size, giant polyps leading to bowel obstruction, or large polyps with JNET type 2B or type3 were included in this study. These polyps were treated with S-EMR method, instead of conventional current methods like utilizing endoloops and clips in the base of stalks: Lift-and-cut technique after formation of adequate submucosal cushion in the base of the pedicle and subsequent prophylactic cauterization of the underlying blood vessels. After the procedure, patients were monitored for vital signs and symptoms of immediate complications for 6 h post-procedure and up to 48 h after discharge.

A total of 48 patients were included in the study. The mean age of the patients was 62.24 years and 41.6 % of them were male. Ten patients had pedunculated and 38 patients had semi-pedunculated polyps. The most common localization of polyps was sigmoid (45.8 %). After S-EMR, no patient had early or late PPB. Four large semi-pedunculated polyps were diagnosed as adenocarcinoma. All had clear margins and no signs of neoplastic submucosal invasion on histologic evaluation.

S-EMR is a safe method for removing thick-stalked, giant, high-risk, and malignant, pedunculated, and semi-pedunculated polyps. It may reduce the risk of PPB and assist in achieving clear margins in malignant polyps.