Abstract
BackgroundMonopolar instruments are generally used in colorectal endoscopic mucosal resection (EMR). Bipolar instruments have previously been reported to be as safe as monopolar instruments. We sought to compare the safety of the monopolar and bipolar snare and hemostatic forceps in an animal model.MethodsWe created 5-mm, 10-mm, and 15-mm target lesions on an ex vivo porcine rectum. Two lesions of each size were resected via monopolar polypectomy (M-P), monopolar EMR (M-E), bipolar polypectomy (B-P), and bipolar EMR (B-E). We performed a pathological evaluation of the conditions of perforation and the effects of burning on the tissues. In addition, we burned the muscularis propria covered with submucosal layer using monopolar and bipolar hemostatic forceps and performed pathological evaluations.ResultsPolypectomy and EMR were performed in a total of 24 target lesions. A perforation was found on histology in one case of M-P and one case of M-E after removing target lesions of 15 mm in diameter. There were no perforations during endoscopic resection using the bipolar snare. The thermal denaturation in B-P did not reach the muscularis propria layer regardless of the size of the target lesion. Although thermal damage after using monopolar hemostatic forceps was extensive, thermal denaturation was only seen on the surface of the submucosal layer when bipolar hemostatic forceps were used.ConclusionsBipolar instruments cause less damage to the tissue than monopolar instruments. Our results also suggest that bipolar instruments may be safer than monopolar instruments in endoscopic procedures for colorectal lesions.
Highlights
Monopolar instruments are generally used in colorectal endoscopic mucosal resection (EMR)
EMR and polypectomy were performed in 24 target lesions
While the thermal denaturation in bipolar polypectomy (B-P) did not reach the muscularis propria layer regardless of the size of the target lesion (Fig. 3), tissue damage without perforation was observed in the muscularis propria layer in most cases of monopolar polypectomy (M-P) (4 in 5 cases, 80%)
Summary
Monopolar instruments are generally used in colorectal endoscopic mucosal resection (EMR). We sought to compare the safety of the monopolar and bipolar snare and hemostatic forceps in an animal model. Reports have shown that detection and resection of adenomatous polyps via screening and therapeutic endoscopy prevent the CRC-related adenoma-carcinoma sequence [1, 2]. Endoscopic resections (ER) including cold or hot biopsy, polypectomy, endoscopic mucosal resection (EMR), and Shinmura et al BMC Gastroenterology (2020) 20:27 bleeding [10,11,12,13], very few reports exist on hemostatic forceps for lower gastrointestinal bleeding, except for during ESD. Few reports have compared the safety of the monopolar and bipolar snare and hemostatic forceps
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