ASGE Advanced Endoscopic Lesion Resection Course (On-Demand) | November 2022-11 Komanduri

11 Komanduri_Managing bleeding, both big and small

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This document discusses the management of bleeding during endoscopic resection of complex lesions. The author emphasizes the importance of understanding the role of the electrosurgical generator and the impact of polyp type and resection technique on bleeding. They also discuss different tools and techniques that can be used for achieving hemostasis during and after the resection.<br /><br />The document highlights the risk of post-polypectomy bleeding (PPB) and factors that can predict delayed bleeding, such as polyp size, polyp type, and the use of antiplatelet and anticoagulative agents. The author presents evidence for the use of cold snare polypectomy (CSP) for polyps ranging from 6-15mm, as it has shown lower rates of incomplete resections and fewer adverse events compared to hot snare polypectomy (HSP).<br /><br />Preventative strategies for bleeding include submucosal injection, snare tip soft coagulation, and prophylactic clipping or injection of the stalk for pedunculated polyps. The document also discusses the use of argon plasma coagulation (APC) for the treatment of visible vessels, with no significant difference in the rate of delayed PPB compared to no APC.<br /><br />Prophylactic clip placement after endoscopic mucosal resection (EMR) has been shown to reduce delayed PPB, especially for proximal polyps larger than 2cm. The document also mentions mechanical hemostasis techniques, such as hemoclips, Over-The-Scope clips (OTSC), endoloops, suturing, and basic tamponade, as options for managing bleeding.<br /><br />The author concludes by encouraging endoscopists to expand the use of cold snare polypectomy, ensure familiarity with a range of hemostatic options, and promote innovation in the field. They emphasize that immediate bleeding during polypectomy can usually be managed with endoscopic techniques, and delayed PPB is rare with non-complex polyps.

Keywords

management of bleeding

endoscopic resection

complex lesions

electrosurgical generator

polyp type

resection technique

hemostasis

post-polypectomy bleeding

polyp size

cold snare polypectomy