Resection Techniques Research Articles

A comparative analysis of prognostic regression models and machine learning algorithms in surgical decision-making of cardial submucosal tumors

Background and aimsNon-tunneling and submucosal tunneling endoscopic resection (STER) techniques are the most frequent treatments for cardial submucosal tumor (SMT). Here, we analyzed common machine learning (ML) algorithms and compared them with traditional regression models in surgical decision-making for cardial SMTs. MethodsUsing key baseline predictive factors, ML algorithms and logistic regression (LR) were conducted in 246 patients. For the ML algorithms, gradient boosting machines (GBM), artificial neural networks (ANN), random forests (RF), and support vector machines (SVM), were included. For small sample-sized data, a technique for k-fold cross-validation was exploited to avoid over-fitting. Meanwhile, we tuned the parameters through several replications. Then, we quantified the discrimination (area under the curve, AUC) and predictive ability (Brier score, F1 score, specificity, sensitivity, and accuracy) of models. We divided patients (n ​= ​246) into STER-treated (n ​= ​97) and non-tunneling endoscopic resection (NTER)-treated (n ​= ​149) groups. ResultsLR outperformed among all groups (Brier score ​= ​0.1398, F1 score ​= ​0.7391, AUC ​= ​0.8729, and predictive accuracy ​= ​80.65 ​%). In comparison to ML algorithms, an outperformance of the traditional regression approach was also found in a low-dimensional setting for surgical decision prediction of cardial SMTs. ConclusionsThe traditional regression approach outperformed ML algorithms for the prediction of the best surgical method in patients with SMTs.

Endoscopic band ligation versus hot snare resection for hyperplastic gastric polyps in cirrhotic patients.

Managing patients with liver cirrhosis and gastric hyperplastic polyps (GHPs) is challenging. Despite being the standard technique for resection of GHPs, hot snare polypectomy (HSP) is risky in the setting of coagulation disorders associated with liver cirrhosis. The aim of the study was to assess the efficacy and safety of endoscopic band ligation (EBL), compared to HSP in resecting GHPs in cirrhotic patients. One hundred consecutive adults with liver cirrhosis and sessile or pedunculated GHPs were enrolled from December 2018 to December 2020. Cases were non-blindly randomized (1 : 1) to two groups to have GHPs managed by either EBL (group I) or HSP (group II). Data of demographic, clinical, and pathological factors, hospitalization expenses and outcomes of both treatment maneuvers were collected and statistically analyzed. Upper endoscopy was repeated for all patients at 3, 6 and 12 months after treatment for recurrence detection. Between the two procedures, the mean operational time was significantly shorter in the EBL than the HSP group (15.1 ±3.80 min vs. 36.6 ±6.72 min, p < 0.001). Concerning complications, 94% of EBL cases had reported no complications compared to 78% with HSP. Bleeding occurred only with HSP (20%) with urgent need for adrenaline and/or argon plasma coagulation (p = 0.003). Regarding cost, it was significantly lower in EBL than HSP (280 ±2.02 EGP vs. 390 ±181.8 EGP, p < 0.001). However, the recurrence rate of GHPs and number of needed sessions were not significantly different. EBL proved to be a safer, more rapid, and economic maneuver when compared to HSP on resecting GHPs in patients with liver cirrhosis.

Our approach to the treatment of vestibular schwannomas with arachnoid dissection of the facial nerve

To evaluate the results of arachnoid dissection of the facial nerve from internal auditory canal when resecting the vestibular schwannoma. We analyzed 61 patients with vestibular schwannomas. Patients were divided into 2 groups depending on surgical technique. We estimated facial nerve function before and after surgery, preoperative dimension of vestibular schwannoma and extent of resection. The influence of various factors on extent of resection and postoperative facial nerve function was studied. Vestibular schwannoma resection from the brain stem was performed in 30 patients, arachnoid dissection - in 31 patients. There was no significant between-group difference. Gross total resection was performed in 78.7% of cases. Both techniques demonstrated similar results regarding extent of resection. Arachnoid dissection showed the advantage regarding facial nerve function immediately after surgery (p=0.012) and 6 months later (p<0.001). Normal facial nerve function in 6 months after arachnoid dissection was observed in 80.7% of patients. Preoperative dimension of tumor influenced facial nerve function in addition to technique of resection (p=0.001). We identified the factors influencing facial nerve function after resection of vestibular schwannoma. Surgical technique was the most significant factor. These data expand and popularize arachnoid dissection in surgery of vestibular schwannomas.

The experience with the Inside-Out Technique for resection of Craniopharyngiomas during Endoscopic Endonasal Approaches (EEAs)

The experience with the Inside-Out Technique for resection of Craniopharyngiomas during Endoscopic Endonasal Approaches (EEAs)

Endoscopic mucosal resection techniques for colorectal polyps

Endoscopic mucosal resection techniques for colorectal polyps

Application of a Standardized Treatment Paradigm as a Strategy to Achieve Optimal Onco-Functional Balance in Glioma Surgery.

Gliomas, characterized by their invasive persistence and tendency to affect critical brain regions, pose a challenge in surgical resection due to the risk of neurological deficits. This study focuses on a personalized approach to achieving an optimal onco-functional balance in glioma resections, emphasizing maximal tumor removal while preserving the quality of life. A retrospective analysis of 57 awake surgical resections of gliomas at the National University Hospital, Singapore, was conducted. The inclusion criteria were based on diagnosis, functional boundaries determined by direct electrical stimulation, preoperative Karnofsky Performance Status score, and absence of multifocal disease on MRI. The treatment approach included comprehensive neuropsychological evaluation, determination of suitability for awake surgery, and standard asleep-awake-asleep anesthesia protocol. Tumor resection techniques and postoperative care were systematically followed. The study included 53 patients (55.5% male, average age 39 years), predominantly right-handed. Over half reported seizures as their chief complaint. Tumors were mostly low-grade gliomas. Positive mapping of the primary motor cortex was conducted in all cases, with awake surgery completed in 77.2% of cases. New neurological deficits were observed in 26.3% of patients at 1 month after operation; most showed significant improvement at 6 months. The standardized treatment paradigm effectively achieved an optimal onco-functional balance in glioma patients. While some patients experienced neurological deficits postoperatively, the majority recovered to their preoperative baseline within 3 months. The approach prioritizes patient empowerment and customized utilization of functional mapping techniques, considering the challenge of preserving diverse languages in a multilingual patient population.

Хірургічні аспекти лікування перфоративних гастродуоденальних виразок із поєднаними ускладненнями пенетрацією, стенозом та гострою кровотечею

The problem of surgical treatment of perforation of gastroduodenal ulcers (GDU) remains relevant and difficult, despite the introduction of new schemes of anti-ulcer and eradication therapy. Algorithms of surgical approaches and tactics of surgical treatment of patients with perforated GDU in combination with other complications in various combinations have not been developed. Purpose - to improve the results of surgical treatment of GDU with associated complications. Materials and methods. The results of surgical treatment of patients with complicated GDU for the period from 2000 to 2022 are presented. In total, 353 (100%) patients with perforated GDU in combination with other complications (a combination of two or more complications) were operated on. There were 52 (14.7%) patients with gastric ulcer perforation, and 301 (85.3%) patients with duodenal perforation. There were 267 (75.6%) patients with a combination of two complications; with a combination of three complications in 78 (22.1%) patients; four - 8 (2.3%) patients. The combination of perforation with gastrointestinal bleeding was observed in 138 (39.1%) patients. Results. The vast majority of patients (267 (75.6%)) had a combination of two complications. The number of patients with a combination of three complications was 78 (22.1%). The number of patients with a combination of all complications was insignificant - 8 (2.3%) people. The implementation of the developed algorithm made it possible to reduce the number of postoperative complications and mortality from 12% to 6.5%. The highest rate of complications and mortality was observed among patients with a combination of multiple (three and four) complications who underwent gastric resection - 3 (33.3%) patients, and the lowest mortality rate was observed among patients who underwent organ-preserving operations - 6 (2.8%) patients. Conclusions. In patients with perforated GDU in combination with bleeding, the use of endoscopic hemostasis made it possible to stabilize the patient and better prepare him for surgical intervention, and reduce the number of postoperative complications and mortality rates by almost 2 times. The use of resection techniques was extremely limited and had the highest rate of complications and mortality. Implementation of the developed algorithm made it possible to optimize surgical tactics when combining perforation with other complications of GDU. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the patients was obtained for the research. No conflict of interests was declared by the authors.

Laparoscopic Hartmann Reversal: A Single Center Five-Years’ Experience

Since 1921, when the french surgeon Henry Albert Hartmann described the technique of recto-sigmoidal resection with end left colostomy and closure of the rectal stump, such operation begun to be used to treat or palliate patients with rectosigmoid pathologies such as rectosigmoid cancer, perforated diverticulitis and more.

Intradural Pituitary Hemitransposition: Technical Note and Case Series Illustration.

Lesions located in the retrosellar region, interpeduncular cistern, and petroclival region are among the most difficult to access in neurosurgery. Transcranial approaches are useful; however, the large distance between the surgeon and the lesion as well as the presence of major neurovascular structures surrounding the lesion may limit surgical exposure. A midline transsphenoidal route avoids transgression of the neurovascular plane and provides direct access to the interpeduncular cistern. To safely access the interpeduncular fossa, it requires mobilization of the pituitary gland. The pituitary hemitransposition technique permits mobilization of the gland, while preserving its venous drainage and arterial supply to the gland on one of its sides, preserving gland function. The authors aim to describe the intradural pituitary hemitransposition technique and to demonstrate its safe application for resection of skull base tumors in the retrosellar space. The authors describe the surgical technique and illustrate its application in 5 cases of different types of skull base tumors, including a video demonstrating all the steps to perform this approach. In addition, the authors discuss the advantages and limitations of this technique compared with other approaches to the retrosellar space. The intradural pituitary hemitransposition technique was used to safely resect a chondrosarcoma, chordoma, craniopharyngioma, teratoma, and meningioma involving the parasellar and retrosellar spaces, while minimizing endocrine morbidity. We had one patient with mild, albeit permanent hyperprolactinemia and hypothyroidism after surgery. No other patients had permanent dysfunction related to surgery. The endonasal endoscopic intradural pituitary hemitransposition approach is an effective technique for resection of lesions located within the retrosellar and petroclival regions, allowing adequate exposure while potentially optimizing the preservation of the pituitary function.

Teknik reseksi mandibula pada autopsi

Background: Jaw resection in the forensic autopsy has a different purpose rather than the usual goals such as removal of the tumor, fracture repair or reducing osteomyelitis. However, the purpose of forensic autopsies is actually to identify the remains of victims who cannot be identified with fingerprints or DNA conventionally or by means of identifying unidentified victims. Objective: This study aims to review jaw resection techniques at autopsy. Method: Scoping review is carried out by analyzing secondary data in the form of journals published from 2008-2021. Results: There were five journals used in this study. The five journals show that the jaw resection procedure starts from an incision first and then a cut is made to the maxilla or mandible. Conclusion: Jaw resection at autopsy is needed for sufficient visibility. It is usually reserved for cases of severely rotting or burned body parts.

Comments on "No-touch endoscopic full-thickness resection technique for gastric gastrointestinal stromal tumors".

Comments on "No-touch endoscopic full-thickness resection technique for gastric gastrointestinal stromal tumors".

Robotic natural orifice specimen extraction surgery (NOSES) for anterior resection.

Minimally invasive colorectal surgery is currently well-accepted, with open techniques being reserved for very difficult cases. Laparoscopic colectomy has been proven to have lower mortality, complication, and ostomy rates; a shorter median length of stay; and lower overall costs when compared to its open counterpart. This trend is seen in both benign and malignant indications. Natural orifice specimen extraction surgery (NOSES) in colorectal surgery was first described in the early 1990s. Three recent meta-analyses comparing transabdominal extraction against NOSES concluded that NOSES was superior in terms of overall postoperative complications, recovery of gastrointestinal function, postoperative pain, aesthetics, and hospital stay. However, NOSES was associated with a longer operative time. Herein, we present our technique of robotic NOSES anterior resection using the da Vinci Xi platform in diverticular disease and sigmoid colon cancers.

Анализ эффективности дозированной хирургической резекции леватора верхнего века при лечении врожденного блефароптоза у детей

Purpose. Analysis of the clinical efficacy of dosed resection of the upper eyelid’s levator in congenital blepharoptosis in children. Material and methods. 54 children with congenital blepharoptosis (54 eyes) from 4 to 14 years old. It was diagnosed mild form in 4 eyes, moderate form in 11 eyes, and severe form in 29 eyes. In 47 children, blepharoptosis was complicated by obscurative amblyopia of various degrees (87%), in 21 children it was combined with concomitant monolateral strabismus: from +10° to +25° Hirschberg. Method of surgical resection of the upper eyelid’s levator with preservation of Whitnall’s ligament: linear skin incision along the orbito-palpebral fold, followed by isolation of the levator and it’s cutting off from the place of attachment to the tarsal plate by 5–18 mm (depending on the degree of ptosis). Three U-shaped sutures were placed through the levator with their subsequent fixation to the tarsal plate, with resection of the levator and two interrupted sutures on the skin with the capture of the underlying tissues in the areas of the outer and inner corners of the eye. All surgeries went as planned with no complications. Results. On the 10th day, 51 children had the correct position of the upper eyelid, in both eyes it became symmetrical. The palpebral fold was well contoured, it also became symmetrical in both eyes. The excursion of the upper eyelids in this group of children corresponded to that in paired eyes. In two children, the width of the palpebral fissure in the operated eyes turned out to be 1–2 mm less than in the healthy ones, in one child hyper effect of the operation was noted, he underwent reoperation. After 3 years, the initially achieved effect of the operation was preserved in 52 children (96.3%). Conclusion. The use of the technique of surgical resection of the upper eyelid’s levator in the treatment of blepharoptosis of various degrees of severity in children showed high clinical efficacy – 96.3% after 3 years of observation. Key words: congenital blepharoptosis in children, ptosis of upper eyelid, dosed resection of upper eyelid’s levator

Single-port intragastric wedge resection using the tunnel method: a novel surgical approach for treating endophytic gastric subepithelial tumors.

Intragastric wedge resection is an effective method for treating endophytic gastric subepithelial tumors (SETs). However, retracting the stomach wall to the umbilicus is difficult in certain patients. In response, we developed a novel surgical technique for single-port intragastric wedge resection, which we termed the "tunnel method." A transumbilical incision is made, and a wound retractor is applied. After diagnostic laparoscopy, a gastrostomy is made on the greater curvature, lower body. Another small wound retractor is inserted into the gastrostomy, and extracted through the transumbilical incision, creating a tunnel from the gastrostomy site to the umbilicus. Articulating laparoscopic instruments are inserted via the tunnel, and intragastric wedge resection is performed. We collected and analyzed the clinicopathologic and operative data of patients who underwent intragastric wedge resection via the tunnel method. Twenty-seven patients who underwent single-port intragastric wedge resection via the tunnel method in a single tertiary referral hospital were included in this study. The mean age of the patients was 54.6 ± 11.4years, body mass index was 26.5 ± 3.4kg/m2. Twenty-four (88.9%) patients had tumors located in the upper third of the stomach. The average operative time was 65.0 ± 24.2min. None of the patients experienced Clavien-Dindo grade IIIa or higher postoperative complications. The average postoperative hospital stay length was 2.5 ± 0.8days. Thirteen gastrointestinal stromal tumors, nine leiomyomas, and one neuroendocrine carcinoma, schwannoma, lipoma, spindle cell proliferative lesion, and fibrotic lesion were pathologically diagnosed. The average tumor size was 2.6 ± 1.3cm. All cases had negative resection margins. Single-port intragastric wedge resection by the tunnel method is a feasible and safe approach for treating endophytic gastric SETs.

Surgical treatment of canine urethral prolapse via urethropexy or resection and anastomosis.

The objective was to report and compare the complications and recurrence rates of urethral prolapse in dogs when treated with urethropexy, resection and anastomosis or a combined surgical technique. Retrospective study. A total of 86 dogs were identified from the medical records of 10 veterinary referral hospitals from February 2012 and October 2022. Dogs were included if they underwent surgery for a urethral prolapse at first presentation. Complications were classified as minor or major based on the necessity of further surgical intervention. Complications leading to death were also considered major complications. Seventy-nine dogs were included, urethropexy (n=44), resection and anastomosis (n=27) and a combined surgical technique (n=8). Minor complications were identified in 41 of 79 dogs (51.9%): urethropexy 19 of 44 (43.2%), resection and anastomosis 18 of 27 (66.6%) and a combined surgical technique four of eight (50%). Major complications occurred in 23 dogs (29.1%), of which 21 were recurrence (26.6%). Recurrence occurred in 17 of 44 dogs following a urethropexy (38.6%), three of 27 dogs following resection and anastomosis (11.1%) and one of eight dogs treated with a combined surgical technique (12.5%). Recurrence of a urethral prolapse was significantly more likely following urethropexy in comparison to resection and anastomosis. Resection and anastomosis was associated with a lower recurrence rate in comparison to urethropexy for the surgical treatment of urethral prolapse. Based on these results, we concluded that resection and anastomosis may be preferable to urethropexy for treatment of urethral prolapse at first presentation. Urethropexy, and resection and anastomosis combined surgical technique was associated with low recurrence rate; however, further studies will be needed to clarify if it provides any benefit over resection and anastomosis.

Comparison of resection and pyelotomic techniques for treating the recurrent pyeloureteral segment in children: A systematic review and meta-analysis

Introduction. The lack of unified therapeutic and diagnostic protocol for managing children with relapsed obstruction of the pyeloureteral segment after ureteropyeloplasty has stimulated us to make a systematic review with meta-analysis on publications that studied indications and effectiveness of resection and endopyelotomic techniques.&#x0D; Material and methods. Primary selection found 276 and 1470 sources in PubMed and Google Scholar database. After reviewing them, five publications were taken for the analysis. The design of the articles was consistent with cohort studies.&#x0D; Results. The total number of patients with recurrent hydronephrosis was 156. All patients included in the review were children aged from 0 to 18 years. The present trial compared the effectiveness of resection and endopyelotomic techniques in treating recurrent hydronephrosis in children. When evaluating fixed effects in the model, the resection techniques showed a statistically significant increase in the weighted average risk of favorable outcomes by 68% (p = 0.001). The average follow-up period of patients after endopyelotomies was 36.6 months, and after resection pyeloplasty – 45.3 months. While analyzing complications, the majority of them predominated in the resection techniques. However, while performing the meta-analysis, this parameter turned out to be statistically insignificant (p = 0.55).&#x0D; Conclusion. The results obtained emphasize high effectiveness of resection techniques as a method for treating recurrent hydronephrosis in children; however, due to high heterogeneity of studies and due to the risk of publication bias, this systematic review requires inclusion of more studies with detailed characteristics of patients and static justification of curative modalities.

"Boot Sign" of Anterior Femoral Condylar Resectional Shape during Total Knee Arthroplasty Is More Frequent in Asian Patients.

There is lack of intraoperative consensus on the distal femur anterior resected surface shape that allows reliable rotational alignment assessment during total knee arthroplasty (TKA). We aimed to evaluate the ratio and prevalence of anterior femoral resection surface intraoperatively. The study included 234 osteoarthritis patients with varus knees and not valgus knees or deformities. After conventional medial parapatellar approach, measured resection technique based on the mechanical axis of the femur and preoperative TEA-PCA angle on CT with anterior reference was used among all the patients. The anteroposterior (AP) lengths after distal femoral resection were measured as the femoral lateral AP (FLAP) and femoral medial AP (FMAP) lengths. Based on the medial (MD) and lateral condyle (LD) vertical distance ratios of the femur anterior resected surface, the groups were classified into "boot sign", "grand-piano", and "butterfly sign" groups. For comparison of the mean values, the data were assessed for normality with the Shapiro-Wilk test. One-way ANOVA with post hoc analysis using Tukey's honestly significant difference (HSD) test was used to compare the mean values among the groups. The correlations between the MD/LD and variables were analyzed using the Pearson correlation coefficient. Linear regression analyses were used to find the associated factors to the anterior femoral resection surface shape. Mean intraoperative femoral rotation and distal femoral cutting angles were 4.9° ± 1.2 and valgus 5.0° ± 0.7, respectively. Mean FLAP was 52.9 ± 4.2 mm. Mean MD/LD (0.61 ± 0.13) was lower than that of typical "grand-piano sign". The morphological shape incidence of the "boot sign" was 62.4%. In the "boot sign" group, the FLAP was found to be smaller than that in the other groups (52.4 ± 4.2 vs. 53.7 ± 4.2 vs. 54.9 ± 2.7; p = 0.02), while the intraoperative femoral rotation angle was found to be larger than in the other groups (5.0 ± 1.2 vs. 4.6 ± 1.1 vs. 4.7 ± 1.2; p = 0.039). The MD/LD-associated factors were FLAP, intraoperative femoral rotation, and distal femoral cutting angles (R2 = 0.268). The femur anterior resection surface shape in TKA was found in the "boot sign" rather than the "grand-piano sign" in Korean ethnics owing to an asymmetric morphology of femoral condyles. Ethnic differences, including distal femoral morphology, should be considered for assessment of the femoral rotation angle using the femur anterior resection surface shape.

Simple and safe resection of the crista galli.

A critical procedure in the transcribriform approach is the resection of the crista galli. However, the standard technique for crista galli resection has several disadvantages. We reviewed the cases of patients with olfactory neuroblastomas who underwent an endoscopic endonasal transcribriform approach using a newly developed technique for crista galli resection. We performed a cadaveric study to measure the superior accessibility limits using the proposed method. We included 38 patients with olfactory neuroblastomas in this study. The tumor invaded the posterior crista galli in four patients. The anterior end of the crista galli was not invaded by the tumor. Our cadaveric study showed that the dura was approachable to the point that was 7.4 ± 1.3 mm superior and 23.2 ± 7.2 mm lateral to the foramen cecum following crista galli removal. By resecting the crista galli in advance, manipulation of the superior dura became feasible.

A novel technique for small-incision levator resection with a double mattress suture for ptosis correction.

To introduce a novel technique for small-incision levator resection in ptosis surgery and evaluate its efficacy in a pilot study among patients affected by congenital or aponeurotic ptosis. We prospectively enrolled congenital and aponeurotic ptosis patients if their levator function was not poor (≥5 mm) from June 2021 through October 2022. Surgical technique involved a 1-cm lid crease incision, minimal dissection, and creating a loop passing through the tarsus and levator aponeurosis. Success was defined as postoperative MRD-1 ≥3 mm and inter-eyelid MRD-1 difference ≤1 mm. Eyelid contour quality was scored excellent, good, fair, and poor according to its curvature and symmetry. Sixty-seven eyes (35 congenital and 32 aponeurotic) were included in the study. Mean age was 34±19 years (range, 5-79 years). Mean preoperative levator function and levator resection amount were 9.53 mm and 8.39 mm in the congenital group and 12.34 mm and 4.15 mm in the aponeurotic group, respectively. Mean pre- and postoperative MRD-1 was 1.61 mm and 3.27 mm respectively (P<0.001). The overall success rate was 82.1% (95% C.I: 71.7-89.8%); the result was failure in 12 cases, of which 11 had under-correction. Preoperative MRD-1 was correlated with a success rate (P=0.017). The described technique shows non-inferior results to the previously described surgical methods and also it shows very good lid contour outcome and minimal lag. The findings suggest that the double mattress single suture technique can be used in both congenital and aponeurotic ptosis.

Endoscopic powered resection device for residual colonic lesions: the first multicenter, prospective, international clinical study

Background and AimsEndoscopic resection is standard treatment for adenomatous colorectal lesions. Depending on lesion morphology and resection technique, recurrence can occur. Scarred adenomas are challenging to resect and may require surgical management. This study evaluated safety and effectiveness of an endoscopic powered resection (EPR) system for scarred adenomatous colorectal lesions. MethodsSingle-arm, prospective, multicenter, study conducted from January 2018 to January 2021 at 12 sites. Patients with persistent flat or sessile colorectal lesions were enrolled. Primary endpoints were technical success (the ability of the device to resect the lesion(s) without use of other resection devices without device-related serious adverse events (SAE)) and safety (the occurrence of adverse events (AE) through 90 days). Secondary endpoints included endoscopic confirmation of resection completeness, occurrence of colon stenosis, disease persistence, and diagnostic value of resected specimens. ResultsSixty-five patients were in the intent-to-treat / safety analysis population. Primary analysis was performed on 45 per-protocol (PP) patients with 48 lesions. All PP-patients were solely treated by the EndoRotor device. Technical success was achieved in 44 (98%) patients. Three (5%) SAEs occurred: 2 delayed self-limited bleeds and 1 perforation. Non-serious AEs included 4 (6%) cases of mild intraprocedural bleeding. Completeness of resection and histopathological diagnosis of tissue specimens were achieved in all patients, 21 (46.7%) patients had disease persistence after the first treatment, and there was no colon stenosis. ConclusionsEPR is a safe and effective for benign, persistent, large (>20mm) scarred, colorectal adenomas and should be considered as an alternative treatment in lieu of surgery. Persistence rate of 46.7% show that more than one treatment are necessary for effective endoscopic treatment.