Clin Endosc.  2023 Sep;56(5):623-632. 10.5946/ce.2022.200.

Evaluation of a new method, “non-injection resection using bipolar soft coagulation mode (NIRBS)”, for colonic adenomatous lesions

• Tokuhara M
• Shimatani M
• Tominaga K
• Nakahira H
• Ohtsu T
• Kouda K
• Naganuma M

• KMID: 2546141
• DOI: http://doi.org/10.5946/ce.2022.200

Abstract

Background/Aims
Endoscopic resection of all colorectal adenomatous lesions with a low complication rate, simplicity, and negative residuals is challenging. Hence, we developed a new method called “non-injection resection using bipolar soft coagulation mode (NIRBS)” method, adapted for colorectal lesions. In addition, we evaluated the effectiveness of this method.
Methods
We performed NIRBS throughout a 12-month period for all colorectal lesions which snare resection was acceptable without cancerous lesions infiltrating deeper than the submucosal layer.
Results
A total of 746 resected lesions were included in the study, with a 4.5 mm mean size (range, 1–35 mm). The major pathological breakdowns were as follows: 64.3% (480/746) were adenomas, and 5.0% (37/746) were intraepithelial adenocarcinomas (Tis lesions). No residuals were observed in any of the 37 Tis lesions (mean size, 15.3 mm). Adverse events included bleeding (0.4%) but no perforation.
Conclusions
NIRBS allowed the resection of multiple lesions with simplicity because of the non-injection and without perforating due to the minimal burn effect of the bipolar snare set in the soft coagulation mode. Therefore, NIRBS can be used to resect adenomatous lesions easily, including Tis lesions, from small to large lesions without leaving residuals.

Keyword

Bipolar snare; Colorectal lesion; Endoscopic mucosal resection; Noninjection; Soft coagulation mode

Figure

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  Fig. 1. Non-injection resection using bipolar soft coagulation mode procedure (NIRBS) Procedure 1. (A) Cecum, 20 mm, sessile type (Is). (B, C) The lesion is grasped by the snare, including the surrounding normal mucosa, while sucking air. (D) Grasped. (E) Squeezed and energized. (F) Resected.

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  Fig. 2. Comparison between non-injection resection using bipolar soft coagulation mode (NIRBS) and the conventional bipolar forced coagulation mode. (A) NIRBS. (B) Conventional bipolar forced coagulation mode (forced, 15 W; effect 2). The thermographs of A and B were taken during energization by attaching the snare to the surface of the saline. The graphs (A) and (B) show the relationship between the electric power and voltage (the red number is the electric voltage in the mode). A comparison of the two thermographs shows that the NIRBS mode has less heat spread to the surface of saline than the conventional bipolar forced coagulation mode. A comparison of the two graphs shows that the electric voltage in the NIRBS mode is approximately 1/4 that in the conventional bipolar forced coagulation mode.

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  Fig. 3. Non-injection resection using bipolar soft coagulation mode procedure 2. (A) Sigmoid colon, 20 mm, semipedunculated type (Isp). (B, C) Snaring. (D) Grasped and squeezed. (E) Resected portion. (F) The resected portion was completely sutured with the clip because there were no mucosal swelling and minimal tissue solidification.

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