ASGE Masterclass: Expert Performance Approach to Colonoscopy (On-Demand)

Video Transcription

Video Summary

Delayed bleeding is the most common complication after electrocautery-based colon polyp resection and often leads to hospitalization and repeat procedures. A randomized trial comparing microprocessor-controlled currents (force coagulation vs Endocut) showed no difference in delayed bleeding; Endocut increased immediate bleeding and had slightly more perforations. Cold resection can reduce delayed bleeding but may increase recurrence, so patient factors and follow-up reliability matter. Epinephrine in injectate reduces immediate bleeding but can cause post-procedure pain and doesn’t prevent delayed bleeding; topical gels were ineffective in a trial. Mechanical closure is most effective: multiple RCTs and meta-analyses support clip closure for lesions ≥20 mm in the proximal colon (right/transverse) when electrocautery is used; it’s cost-effective for high-risk lesions. Clips are less effective in the left colon, possibly due to early dislodgement. Proper clip technique and recognizing “clip artifact” (granulation/inflamed bumps mimicking recurrence) are emphasized; pit pattern helps differentiate true recurrence.

Asset Subtitle

Doug Re

Keywords

delayed post-polypectomy bleeding

electrocautery colon polyp resection

Endocut vs force coagulation trial

cold snare resection recurrence risk

prophylactic clip closure proximal colon ≥20 mm

clip artifact vs polyp recurrence pit pattern