ASGE Advanced Endoscopic Lesion Resection Course | November 2022-4 Benson_Fibrotic fixes use of avulsie and ablative therapies for fibrotic lesions

4 Benson_Fibrotic fixes use of avulsie and ablative therapies for fibrotic lesions

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The document discusses three methods for managing fixed lesions, including submucosal fibrosis that causes non-lifting in the gastrointestinal tract. The first method mentioned is Cap Assisted Avulsion, which involves the use of a cap during endoscopic resection. A multicenter study found that this method had a 97% initial complete polyp removal rate but had a 19% recurrence rate and a 9% risk of delayed bleeding. Another review of 124 colon lesions found a 91% complete eradication rate and a 10% complication rate, including a 4% perforation rate.<br /><br />The second method discussed is the use of the EndoRotor, a nonthermal, powered endoscopic debridement instrument. In a pilot study involving 19 patients with fibrotic polyps, the EndoRotor achieved an 84% complete resection rate. In a retrospective review of 41 lesions, the EndoRotor had a 98% initial successful resection rate, a 79% clinically successful resection rate, and a 29% risk of intraprocedural bleeding.<br /><br />The third method mentioned is Hot Biopsy Avulsion, which involves using heat to remove smaller mucosal areas. Retrospective reviews found that Hot Biopsy Avulsion had a 100% index complete resection rate and an 18% recurrence rate. Another study found no perforations in a retrospective review of 112 lesions treated with this method.<br /><br />In summary, Cap Assisted Avulsion, the EndoRotor, and Hot Biopsy Avulsion are all considered safe and effective methods for managing fixed lesions. However, they each have their limitations and potential complications, such as mural injury, recurrence rates, and the risk of bleeding. Further research and evaluation are necessary to determine the most appropriate method for each individual case.

Keywords

managing fixed lesions

submucosal fibrosis

Cap Assisted Avulsion

endoscopic resection

complete polyp removal rate

EndoRotor

complete resection rate

Hot Biopsy Avulsion

mucosal areas

individual case