Original articleClinical endoscopyClip artifact after closure of large colorectal EMR sites: incidence and recognition
Section snippets
Methods
We performed a retrospective assessment of the appearance of clip artifact in a database of large colorectal lesions maintained for quality-control purposes. The database contains relevant information on all large (≥20 mm) nonpedunculated lesions resected by D.K.R. since January 2000. This information is prospectively and periodically updated.1 Permission to review the deidentified database was obtained from the Institutional Review Board at Indiana University Health with exempt status. To be
Results
There were 322 EMR sites in 284 patients that were clipped, and had the first follow-up colonoscopy at our site, of which 19 had no or inadequate photographs of the EMR scar at follow-up. These 19 were excluded from further analysis. Of the 19 excluded polyps, none were treated with thermal therapy at follow-up of the site, all had biopsy specimens taken of the scar, none had histologic evidence of residual polyp. There were 303 EMR sites with high-quality photographs, and of these, all but 18
Discussion
In this study, we present the first description of clip artifact in colorectal EMR scars. The incidence of clip artifact was 31.7%, and clip artifact was considerably more common than residual polyp. Thus, colonoscopists who use clipping to close colorectal EMR sites or who may be performing colonoscopy on patients in whom others have performed EMR with clipping should be aware of and able to identify clip artifact in EMR scars. Our data show that clip artifact can be reliably differentiated
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Cited by (24)
Outcomes of Deep Mural Injury After Endoscopic Resection: An International Cohort of 3717 Large Non-Pedunculated Colorectal Polyps
2022, Clinical Gastroenterology and HepatologyAssessment of submucosal distortion and mass effect seen at follow-up after colorectal EMR with ORISE (with video)
2022, Gastrointestinal EndoscopyCitation Excerpt :Finally, the agreement in scores among the experts was minimal. This may reflect an absence of formal training in using the score, the substantial experience difference between the experts in colorectal EMR and ORISE use, and the potential for some scores to have been confused by mucosal clip artifact.12,13 In summary, endoscopists using ORISE to perform EMR must be aware of possible submucosal mass effects when the EMR scar is inspected at follow-up.
Endoscopic Removal of Colorectal Lesions—Recommendations by the US Multi-Society Task Force on Colorectal Cancer
2020, GastroenterologyCitation Excerpt :Clip artifact has been described at the scar sites in up to one-third of post-EMR clipped defects, irrespective of clip retention. It is characterized by nodular elevation of the mucosa with a normal pit pattern, and should not be mistaken for residual neoplastic polyp in order to avoid unnecessary treatment or inappropriate surveillance interval.150,151 The majority of EMR sites (>90%) do not have clips retained at the first 3- to 6-month surveillance colonoscopy, and moreover, residual polyp at the base of retained clips was not encountered, by either endoscopic or histologic assessment.152
Endoscopic Removal of Colorectal Lesions—Recommendations by the US Multi-Society Task Force on Colorectal Cancer
2020, Gastrointestinal EndoscopyCitation Excerpt :Clip artifact has been described at the scar sites in up to one-third of post-EMR clipped defects, irrespective of clip retention. It is characterized by nodular elevation of the mucosa with a normal pit pattern, and should not be mistaken for residual neoplastic polyp in order to avoid unnecessary treatment or inappropriate surveillance interval.150,151 The majority of EMR sites (>90%) do not have clips retained at the first 3- to 6-month surveillance colonoscopy, and moreover, residual polyp at the base of retained clips was not encountered, by either endoscopic or histologic assessment.152
Closure of Defects and Management of Complications
2019, Gastrointestinal Endoscopy Clinics of North AmericaSafety and efficacy of hot avulsion as an adjunct to EMR (with videos)
2019, Gastrointestinal Endoscopy
DISCLOSURE: Dr Rex is on the Speakers Bureau of Boston Scientific. All other authors disclosed no financial relationships relevant to this article. This work was funded by a gift from Scott and Kay Schurz of Bloomington, Indiana.