Endoscopic mucosal resection with the grasp-and-snare technique through a double-channel endoscope in humans

Background: EMR is being used to manage premalignant lesions of the GI tract. Lifting of the lesion is required to perform EMR. Earlier biopsy or snare may cause scarring and preclude adequate lifting. Objective: We report our experience with a novel grasp-and-snare EMR technique that can be used when a good lifting is not achieved or the location of the lesion is challenging for standard EMR, such as in a fold. Design: Single-center case series. Setting: Tertiary referral academic gastroenterology unit. Patients: Patients referred for endoscopic treatment of flat gastrointestinal polyps. Interventions: Single-session EMR performed with a grasp-and-snare technique through a double-channel gastroscope or colonoscope. Main Outcome Measurements: Technical success, complication rates, and recurrence rates. Results: Seventeen patients with flat gastrointestinal polyps were referred: mean age 70 years, 11 (65%) male, polyp size 0.8 to 6 cm; 13 colonic, 2 duodenal, 1 gastric, and 1 esophageal EMR performed with grasp-and-snare technique in single sessions. Six polyps (35%) did not lift after injection of hydroxypropylmethylcellulose. Fourteen polyps (82%) were resected completely. Two complications occurred (12%): 1 bleeding treated medically and 1 perforation treated surgically. Residual disease at 1 year was 18%, but 8 patients (47%) had not yet had their 1-year follow-up. Limitations: Single-center, uncontrolled, not randomized. Limited follow-up. Conclusions: The grasp-and-snare technique can be used to perform EMR with good outcomes and low complication rates in areas where poor lifting and accessibility are problems.