Hot avulsion: a modification of an existing technique for management of nonlifting areas of a polyp (with video)

Background Endoscopic management of the nonlifting areas of a colonic polyp is a significant challenge. The traditional approach has been to use ablative techniques with mixed long-term results. Objective To evaluate the safety and efficacy of hot avulsion (HA), a modification in the use of hot biopsy forceps in the management of the nonlifting areas of a colonic polyp. Design Retrospective review of data from a prospectively maintained colonic Endoscopic Mucosal Resection database. Setting Tertiary referral hospital. Patients and Intervention Twenty patients in whom HA was used as part of the polypectomy technique. Main Outcome Measurements Location and size of polyp, reasons for nonlifting, immediate success, residual rates, and adverse events. Results In our 20 patients studied, the main reasons for nonlifting were scarring from previous EMR attempts in 55% and scarring from previous biopsy in 35%. Mean size of avulsion was 4.4 mm (range, 1-15 mm). At the index procedure, HA was successful in removing macroscopic adenomatous tissue in all patients. At follow-up examinations, 85% (17/20) had no macroscopic or microscopic neoplasia residual and 15% (3/20) had a small area of residual that was easily treated with repeat HA. There were no immediate or long-term adverse events. Limitations Nonrandomized, single-center experience. Conclusions HA appears to be a safe and effective adjunct treatment to snare polypectomy for nonlifting areas of a colonic polyp. Further randomized multicenter studies are required with direct comparison to established techniques.