Knife-assisted snare resection: a novel technique for resection of scarred polyps in the colon

Background and study aims: 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. Patients and methods: This was a prospective cohort study of patients, in whom the KAR technique was used to resect scarred colonic polyps> 2cm 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. Results: A total of 42 patients underwent KAR of large (median 40mm) 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%. Conclusions: KAR of scarred colonic polyps by an expert endoscopist was an effective and safe technique with low recurrence rates.