Snare tip soft coagulation achieves effective and safe endoscopic hemostasis during wide-field endoscopic resection of large colonic lesions

Background: Wide-field EMR (WF-EMR) of large colonic lesions exposes submucosal vessels, which may result in intraprocedural bleeding (IPB). Ongoing bleeding may obscure the endoscopic field, prolonging the procedure and reducing safety and accuracy. A number of potential interventions to control bleeding exist; however, they have inherent limitations. Safe, readily applicable, inexpensive, and effective therapy to control EMR-IPB has not yet been described. Objective: To evaluate the safety and efficacy of the snare tip soft coagulation (STSC) technique to control IPB after WF-EMR of large colonic lesions. Design: Single-center, prospective cohort study. Setting: Tertiary care referral center. Patients: A total of 196 patients undergoing wide-field colonic EMR for flat and sessile lesions 20 mm or larger. Interventions: A standard inject-and-resect EMR technique was applied. IPB was defined as bleeding obscuring the endoscopic field that persisted for 60 seconds or longer. STSC was performed by using the tip of the polypectomy snare to apply soft coagulation (80 W) to sites of IPB. Main Outcome Measurements: Immediate hemostasis, postprocedural bleeding, and other adverse events. Results: A total of 198 lesions (mean size 41.5 mm, 64% in the right colon) were removed in 196 patients (mean age 68 years, 52.5% male). STSC alone achieved effective hemostasis in 40 of 44 cases of IPB (91%). In the remaining 4 cases, additional treatment with coagulating forceps or clips was required to achieve hemostasis. There were no immediate STSC-related adverse events. There was no statistically significant difference between the IPB and non-IPB groups in relation to the use of antiplatelet (P = .2) or anticoagulation agents (P = .4), postprocedural bleeding (P = .8) and adverse event rates (P = .7). Limitations: Nonrandomized study. Conclusions: STSC is a simple and efficient first-line technique for achieving hemostasis of IPB during WF-EMR in the colon. It succeeds in the majority of cases and appears to be safe.