LOW-POWER PURE-CUT HOT SNARE POLYPECTOMY FOR COLORECTAL TUMORS (WITH A VIDEO)

Abstract

The development of colorectal cancer is associated with the adenoma-carcinoma sequence, and the detection and endoscopic resection of colorectal adenomas, which are precancerous lesions, have been shown to reduce the incidence and mortality of colorectal cancer. The standard treatments for lesions ＞ 10 mm are hot snare polypectomy (HSP) and EMR. However, the proportion of invasive cancers 10-19 mm in size is low, and safer new techniques are required. We focused on the settings of the high-frequency power supply in HSP and developed a low-power pure-cut (LPPC) HSP that minimizes thermal injury to the muscular layer while allowing for appropriate submucosal resection using the low-output pure cutting mode (PureCut mode). In animal model studies, LPPC HSP resected the submucosal layer in all cases while preserving a thicker residual submucosal layer and reducing thermal injury to the muscularis propria compared with conventional HSP. Furthermore, clinical trials have evaluated the application of LPPC HSP for colorectal adenomas 10-14 mm in size, confirming a 100% success rate, a high en bloc resection rate, and an R0 resection rate, while minimizing adverse events (only one case of immediate bleeding [1.1%]).

Compared to HSP and EMR, LPPC HSP can reduce thermal injury and improve safety while resecting superficial parts of the submucosal layer. This technique may become a new standard treatment, particularly for colorectal adenomas 10-14 mm in size.