Hyun Jae Kim MD , Douglas Motomura MD , Eric C.S. Lam MD, MSc , Neal Shahidi MD, PhD
{"title":"识别不可能:碎片冷陷阱切除穿孔","authors":"Hyun Jae Kim MD , Douglas Motomura MD , Eric C.S. Lam MD, MSc , Neal Shahidi MD, PhD","doi":"10.1016/j.vgie.2025.03.028","DOIUrl":null,"url":null,"abstract":"<div><h3>Background and Aim</h3><div>Piecemeal cold snare resection (CSR) is an increasingly adopted technique for large nonpedunculated colorectal polyps because of its favorable safety profile. Although adverse events are rare, perforation after CSR has been reported infrequently. We present a video case of intraprocedural perforation during piecemeal CSR.</div></div><div><h3>Methods</h3><div>A 63-year-old woman with quiescent colonic Crohn disease underwent dysplasia surveillance, revealing multiple flat polyps, including 2 adjacent large 0-IIA transverse colon polyps. Piecemeal CSR was performed using chromoinjectate and a 10-mm cold snare. Careful inspection of the resection base with submucosal chromoendoscopy revealed a type IV deep mural injury, despite the absence of electrocautery. The defect was closed using through-the-scope clips. The patient was observed and discharged with antibiotics, with no delayed adverse events at follow-up. Histopathology confirmed sessile serrated lesions without dysplasia.</div></div><div><h3>Conclusion</h3><div>This case demonstrates that perforation, although rare, can occur during CSR. Endoscopists should perform meticulous resection base assessments, as the absence of cautery may obscure signs of deep mural injury.</div></div>","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"10 8","pages":"Pages 422-424"},"PeriodicalIF":0.0000,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Identifying the impossible: piecemeal cold snare resection perforation\",\"authors\":\"Hyun Jae Kim MD , Douglas Motomura MD , Eric C.S. Lam MD, MSc , Neal Shahidi MD, PhD\",\"doi\":\"10.1016/j.vgie.2025.03.028\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background and Aim</h3><div>Piecemeal cold snare resection (CSR) is an increasingly adopted technique for large nonpedunculated colorectal polyps because of its favorable safety profile. Although adverse events are rare, perforation after CSR has been reported infrequently. We present a video case of intraprocedural perforation during piecemeal CSR.</div></div><div><h3>Methods</h3><div>A 63-year-old woman with quiescent colonic Crohn disease underwent dysplasia surveillance, revealing multiple flat polyps, including 2 adjacent large 0-IIA transverse colon polyps. Piecemeal CSR was performed using chromoinjectate and a 10-mm cold snare. Careful inspection of the resection base with submucosal chromoendoscopy revealed a type IV deep mural injury, despite the absence of electrocautery. The defect was closed using through-the-scope clips. The patient was observed and discharged with antibiotics, with no delayed adverse events at follow-up. Histopathology confirmed sessile serrated lesions without dysplasia.</div></div><div><h3>Conclusion</h3><div>This case demonstrates that perforation, although rare, can occur during CSR. Endoscopists should perform meticulous resection base assessments, as the absence of cautery may obscure signs of deep mural injury.</div></div>\",\"PeriodicalId\":55855,\"journal\":{\"name\":\"VideoGIE\",\"volume\":\"10 8\",\"pages\":\"Pages 422-424\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-03-22\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"VideoGIE\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2468448125000761\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"VideoGIE","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2468448125000761","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}
Identifying the impossible: piecemeal cold snare resection perforation
Background and Aim
Piecemeal cold snare resection (CSR) is an increasingly adopted technique for large nonpedunculated colorectal polyps because of its favorable safety profile. Although adverse events are rare, perforation after CSR has been reported infrequently. We present a video case of intraprocedural perforation during piecemeal CSR.
Methods
A 63-year-old woman with quiescent colonic Crohn disease underwent dysplasia surveillance, revealing multiple flat polyps, including 2 adjacent large 0-IIA transverse colon polyps. Piecemeal CSR was performed using chromoinjectate and a 10-mm cold snare. Careful inspection of the resection base with submucosal chromoendoscopy revealed a type IV deep mural injury, despite the absence of electrocautery. The defect was closed using through-the-scope clips. The patient was observed and discharged with antibiotics, with no delayed adverse events at follow-up. Histopathology confirmed sessile serrated lesions without dysplasia.
Conclusion
This case demonstrates that perforation, although rare, can occur during CSR. Endoscopists should perform meticulous resection base assessments, as the absence of cautery may obscure signs of deep mural injury.
期刊介绍:
VideoGIE, an official video journal of the American Society for Gastrointestinal Endoscopy, is an Open Access, online-only journal to serve patients with digestive diseases. VideoGIE publishes original, single-blinded peer-reviewed video case reports and case series of endoscopic procedures used in the study, diagnosis, and treatment of digestive diseases. Videos demonstrate use of endoscopic systems, devices, and techniques; report outcomes of endoscopic interventions; and educate physicians and patients about gastrointestinal endoscopy. VideoGIE serves the educational needs of endoscopists in training as well as advanced endoscopists, endoscopy staff and industry, and patients. VideoGIE brings video commentaries from experts, legends, committees, and leadership of the society. Careful adherence to submission guidelines will avoid unnecessary delays, as incomplete submissions may be returned to the authors before initiation of the peer review process.