ASGE Endoscopy Course at ACG: Everyday Endoscopy: Expertise Meets Evidence | October 2024-22_Rex Bleeding Perforation and Incomplete Resection ASGE at ACG.pdf22_Rex Bleeding Perforation and Incomplete Resection

22_Rex Bleeding Perforation and Incomplete Resection ASGE at ACG.pdf22_Rex Bleeding Perforation and Incomplete Resection

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The document presents an overview of strategies for managing adverse events during polypectomy, focusing on bleeding, perforation, and incomplete resection. Authored by Douglas K Rex from Indiana University School of Medicine, it acknowledges the support and interests of several pharmaceutical and medical device companies, indicating potential collaborations in research and product development.<br /><br />The document outlines current techniques for endoscopic resection in the colorectal area, specifying methods based on lesion size and type. Small lesions up to 3 mm are typically managed with cold forceps, while those over 10 mm often utilize cold snaring techniques. For adenomas, the approach varies with size, using either cold or hot Endoscopic Mucosal Resection (EMR) or Endoscopic Submucosal Dissection (ESD), with Full-Thickness Resection Device (FTRD) as a supplementary option in specific cases.<br /><br />Key topics covered include strategies for the prevention and treatment of bleeding, incomplete resection, and perforation. Techniques such as electrocautery, clip closure, and various snaring methods are discussed for managing bleeding. The document advocates for cold EMR and piecemeal snaring to reduce incomplete resection rates.<br /><br />Addressing perforation, it highlights the use of underwater EMR and clip closure techniques for different types of muscle injuries, emphasizing the importance of identifying a "target sign" in the specimen as an indicator for effective closure. The document also briefly touches on managing recurrence and treating perforations resulting from more severe injuries, such as Type 4 and 5 muscle injuries.<br /><br />In conclusion, the paper emphasizes the necessity of effective strategies for preventing and managing bleeding, incomplete resection, and perforation to improve polypectomy outcomes. These strategies are crucial for maintaining patient safety and treatment efficacy in colorectal procedures.

Keywords

polypectomy

adverse events

bleeding management

perforation

incomplete resection

endoscopic resection

colorectal procedures

electrocautery

clip closure

Douglas K Rex