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Related Concept Videos

Endoscopic Procedures II: Colonoscopy01:25

Endoscopic Procedures II: Colonoscopy

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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:
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Inflammatory Bowel Disease V: Surgical Management01:21

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Surgical interventions for inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn's disease, are essential in managing symptoms and addressing complications. The selection of surgical procedures is contingent upon the specific conditions and complications that stem from these illnesses.
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Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy01:26

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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.
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Related Experiment Video

Updated: Mar 29, 2026

The Pocket-Creation Procedure of Endoscopic Submucosal Dissection for Large Rectal Laterally Spreading Tumors
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Cost-Effectiveness Analysis of Defect Closure Techniques After Conventional Endoscopic Mucosal Resection for Large

Himesh B Zaver1, Jason Erno2, Olivia Reszczynski2

  • 1Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, VA, USA. psh8nw@uvahealth.org.

Digestive Diseases and Sciences
|March 28, 2026
PubMed
Summary

Through-the-scope clips (TTSC) are the most cost-effective method for closing defects after large colon polyp removal via endoscopic mucosal resection (EMR). This strategy offers favorable clinical and economic outcomes for healthcare payers.

Keywords:
Adjusted life yearCostDecisionEffectiveness analysisEffectiveness ratioEndoscopic mucosal resectionIncremental costQualityTree model

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Structured Approach to Colonoscopy Technique Optimization: A Single-Center Experience with Novice Endoscopists
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Area of Science:

  • Gastroenterology
  • Health Economics
  • Medical Device Technology

Background:

  • Delayed bleeding is a significant risk following endoscopic mucosal resection (EMR) of large colon polyps.
  • Effective defect closure strategies are crucial to mitigate post-polypectomy bleeding.
  • Evaluating the economic impact of different closure techniques is essential for healthcare resource allocation.

Purpose of the Study:

  • To assess the cost-effectiveness of single- and dual-modality defect closure techniques after conventional hot snare EMR of large colon polyps.
  • To compare the economic and clinical outcomes of various closure methods from a healthcare payer perspective.

Main Methods:

  • A decision-tree cost-effectiveness analysis was conducted.
  • The model simulated the management of a 20 mm right-sided colon polyp removed by hot snare EMR.
  • Data were pooled from 4817 patients, evaluating closure techniques including through-the-scope clips (TTSC), through-the-scope suturing (TTSS), and hemostatic agents (HA), as well as multimodal combinations.

Main Results:

  • Through-the-scope clips (TTSC) emerged as the most cost-effective strategy, with a total cost of $3842 and 17.17 quality-adjusted life-years.
  • Hemostatic agent (HA) and multimodal strategies (TTSS + TTSC, TTSC + HA) showed marginally higher effectiveness but incurred greater costs, resulting in less favorable cost-effectiveness.
  • Sensitivity analyses confirmed TTSC's cost-effectiveness, remaining viable up to a clip cost of $544.86 and with technical success rates of at least 67%.

Conclusions:

  • Through-the-scope clips (TTSC) offer favorable clinical and economic outcomes for defect closure after large colon polyp EMR.
  • The selection of the optimal closure strategy is influenced by institutional costs and procedural expertise.
  • TTSC represents a cost-effective approach, particularly from a healthcare payer's viewpoint.