Abstract
Objective: Endoscopic resection (ER) is more difficult and has a higher rate of complications, such as perforation and bleeding. The aim of this study was to evaluate the safety and feasibility of a bipolar polypectomy snare for ER.Methods: Initial ER procedures in live pigs were carried out. Then, a human feasibility study was performed in patients with colorectal polyps. Finally, the finite element method was used to evaluate the safety and effectiveness of the new bipolar snare.Results: In the live animal model, there were no significant differences in wound size and cutting time between monopolar and bipolar groups. The histological results (histological scores) of the two groups in porcine experiments were almost the same except that the incision flatness of bipolar group was better than that of the monopolar group. Incidence of bleeding and perforation was similar between the two groups in pigs' and patients' study. At last, the finite element model showed that the vertical thermal damage depth produced by bipolar snare system was approximately 71–76% of that produced by monopolar snare system at the same power.Conclusions: The novel bipolar snare is feasible in patients with colorectal polyps and can be an alternative choice for ERs.
Highlights
Cancer of the digestive tract such as esophageal cancer, gastric cancer, and colorectal cancer is a major cause of morbidity and mortality worldwide [1]
During the process of cutting mucosa of digestive tract, the average wound area of monopolar snare group was 123.1 ± 103.23 mm2, and the mean cutting time was 1.62 ± 1.06 s; the average wound area produced by bipolar snare was 76.68 ± 58.59 mm2, and the mean cutting time was 1.68 ± 1.10 s
The visible wounds of the digestive tract produced by the two snares were shown in Supplementary Figure 3
Summary
Cancer of the digestive tract such as esophageal cancer, gastric cancer, and colorectal cancer is a major cause of morbidity and mortality worldwide [1]. Performing endoscopy screening is an important way to decrease mortality of digestive tract cancer. Screening and therapeutic endoscopy enable early detection and removal of cancer in the digestive tract, which significantly reduce cancer-related mortality [2,3,4]. Therapeutic colonoscopy, including colon polypectomy and endoscopic mucosal resection (EMR), has recently been widely performed as an effective and less invasive treatment strategy [5, 6]. This treatment, called “day surgery,” can be performed without hospitalization. Even when small lesions are removed, this treatment still poses an unavoidable risk of complications, such as bleeding or perforation [7,8,9]
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