ASGE Advanced Endoscopic Lesion Resection Course (On-Demand) | 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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This document discusses various techniques for managing fixed lesions, specifically submucosal fibrosis that leads to non-lifting of lesions during endoscopic procedures. The outlined techniques include Cap Assisted Avulsion, EndoRotor (a nonthermal, powered endoscopic debridement instrument), and Hot Biopsy Avulsion.<br /><br />Cap Assisted Avulsion is a safe and effective method that has a high success rate in removing polyps initially. However, there is a 19% recurrence rate and a risk of mural injury. In a multicenter study, 97% of initial polyp removals were complete, with a 9% rate of delayed bleeding.<br /><br />The EndoRotor, a novel device, is also a safe and effective option for removing fibrotic polyps. In a pilot study, 84% of patients achieved complete resection. However, the procedure takes time and carries a risk of intraprocedural bleeding. A retrospective review of 41 lesions showed a 98% initial successful resection rate and a 79% clinically successful resection rate.<br /><br />Hot Biopsy Avulsion is another safe and effective technique, particularly for smaller mucosal areas. It requires time and has an 18% recurrence rate. Retrospective reviews showed a 100% index complete resection rate with no perforations reported.<br /><br />In summary, Cap Assisted Avulsion, EndoRotor, and Hot Biopsy Avulsion are all viable options for managing fixed lesions. Each technique has its own advantages and limitations. Cap Assisted Avulsion is safe and effective but carries a risk of recurrence and mural injury. EndoRotor is a novel and effective device but requires time and carries a risk of bleeding. Hot Biopsy Avulsion is safe and effective for smaller lesions but also requires time and has a recurrence rate.

Keywords

managing fixed lesions

submucosal fibrosis

non-lifting lesions

endoscopic procedures

Cap Assisted Avulsion

EndoRotor

Hot Biopsy Avulsion

polyp removal

fibrotic polyps

resection rate