GI Now for Group Practice-Managing Residual/Recurrent Adenoma

Video Transcription

Video Summary

The video transcript discusses the management of residual and recurrent adenoma after initial endoscopic removal. The speaker explains that residual or recurrent adenoma rates can be up to 14%, and a strict surveillance colonoscopy protocol is required to detect and manage these cases. Risk factors for finding residual or recurrent adenoma include larger size, unfavorable or difficult locations, sessile or depressed morphology, non-lifting areas, advanced histology, and previous use of certain techniques during the procedure. The speaker describes two scoring systems, the SIRT score and the SMSA grade, which can help predict the chances of recurrence. They also discuss studies that have shown a lower recurrence rate for sessile serrated lesions compared to adenomas. The speaker emphasizes the importance of endoscopist skill and experience in reducing recurrence rates, and highlights various techniques that can be used to decrease the risk of recurrence, such as meticulous technique during the initial endoscopic removal, thermal ablation of the margins, lesion marking, and adjunctive methods like hot avulsion, cold avulsion, and underwater EMR. The speaker shows video demonstrations of these techniques and provides evidence from studies supporting their effectiveness. They also discuss the importance of accurately recognizing recurrence using white light and narrow band imaging and explain various methods for treating recurrence, including snare tip soft coagulation and other newer techniques like the endo-rotor and full thickness resection devices. The overall goal is to avoid surgery and successfully manage residual and recurrent adenoma through endoscopic methods.

Asset Subtitle

Amit Rastogi, MD, FASGE

Keywords

residual adenoma

recurrent adenoma

endoscopic removal

surveillance colonoscopy

risk factors

sessile serrated lesions

endoscopist skill