Thématique :
- Endoscopie/Imagerie
Originalité :
Solidité :
Doit faire évoluer notre pratique :
Nom du veilleur :
Docteur Edouard Chabrun
Coup de coeur :
  2016 Mar;48(3):277-80  
  doi: 10.1055/s-0035-1569647  
  Knife-assisted snare resection: a novel technique for resection of scarred polyps in the colon  
  Chedgy FJ, Bhattacharyya R, Kandiah K, Longcroft-Wheaton G, Bhandari P  


There have been significant advances in the management of complex colorectal polyps. Previous failed resection or polyp recurrence is associated with significant fibrosis, making endoscopic resection extremely challenging; the traditional approach to these lesions is surgery. The aim of this study was to evaluate the efficacy of a novel, knife-assisted snare resection (KAR) technique in the resection of scarred colonic polyps.


This was a prospective cohort study of patients, in whom the KAR technique was used to resect scarred colonic polyps > 2 cm in size. Patients had previously undergone endoscopic mucosal resection (EMR) and developed recurrence, or EMR had been attempted but was aborted as a result of technical difficulty.


A total of 42 patients underwent KAR of large (median 40 mm) scarred polyps. Surgery for benign disease was avoided in 38 of 41 patients (93 %). No life-threatening complications occurred. Recurrence was seen in six patients (16 %), five of whom underwent further endoscopic resection. The overall cure rate for KAR in complex scarred colonic polyps was 90 %.


KAR of scarred colonic polyps by an expert endoscopist was an effective and safe technique with low recurrence rates.

Question posée
Intérêt de la résection mixte (dissection + anse) pour la résection des larges polypes cicatriciels coliques.
Question posée
Etude prospective incluant 41 patients avec des polypes de plus de 2cm. 93% des polypes ont pu être réséqués sans chirurgie. Aucune complication grave ne s’est porduite (pas de perforation).

Cette technique mixte de résection associant la dissection à la résection standard à l’anse semble être fiable et sur pour des polypes habituellement confiés aux chirurgiens.

Nous avons donc maintenant 2 nouvelles techniques endoscopiques pour la prise en charge de ces polypes compliqués. Cette technique mixte pour les polypes de plus de 2cm et la résection trans-pariétale à l’aide du clip OVESCO ® pour ceux de 0 à 2cm.