Introduction

Immediate bleeding is a frequent adverse event during endoscopic resection of large pedunculated polyps. Moreover, these lesions often exhibit a high rate of stalk invasion. Conventional techniques involving preventive mechanical hemostasis necessitate resection near the polyp head, raising concerns regarding oncologic safety. Therefore, alternative endoscopic strategies that address these limitations are required.

Aims & Methods

The aim of this study was to evaluate the safety and efficacy of forced coagulation combined with clip closure after low-stalk resection, as a novel approach for the endoscopic removal of pedunculated polyps.
In this prospective study, 127 pedunculated polyps (head diameter > 20 mm; stalk length > 10 mm) were randomly assigned to two groups:
• Group 1 (Endocut Group) – 64 polyps, treated in accordance with ESGE guidelines (injection with 1:10,000 adrenaline and/or prophylactic mechanical hemostasis, followed by hot snare polypectomy using Endocut Q).
• Group 2 (Forced Coagulation Group) – 63 polyps, treated via direct hot snare resection using pure forced coagulation, followed by prophylactic clip closure. Resection was performed low on the stalk.
Outcomes assessed included:
• Incidence of serious adverse events (immediate bleeding, delayed bleeding, perforation);
• Complete resection rate;
• Subanalysis of unfavorable histologic features, including malignancy and depth of invasion.

Results

Serious adverse events occurred in 9.5% of patients in the Endocut Group versus 6% in the Forced Coagulation Group (p < 0.005).
• Immediate bleeding: 16% in Endocut vs. 9% in Forced Coagulation Group.
• Delayed bleeding: 11% in Endocut vs. 3.1% in Forced Coagulation Group.
• Perforation: None reported in either group.
Complete resection rates did not differ significantly between the groups (p > 0.005).
Malignancy was identified in 11% of polyps overall. Notably, Haggit level 4 lesions were observed exclusively in the Endocut Group.

Conclusion

Forced coagulation followed by clip closure, with low-stalk resection, represents a safe and effective alternative for the endoscopic removal of large pedunculated polyps. This method is associated with a significantly lower incidence of adverse events—particularly bleeding—and may offer superior oncologic outcomes in malignant cases, compared with standard techniques.

Introduction

Colon capsule endoscopy (CCE) or panenteric capsule endoscopy (PCE) offers a promising, non-invasive diagnostic approach for patients with iron deficiency anaemia (IDA). However, high rates of conversion to conventional colonoscopy (CCC) following capsule procedures reduce cost-effectiveness and patient satisfaction. Optimising the faecal immunochemical test (FIT) threshold may improve patient stratification and reduce unnecessary conversions in future applications within the IDA diagnostic pathway.

Aims & Methods

This study aimed to evaluate the accuracy of faecal immunochemical testing (FIT) in predicting colorectal cancer (CRC) and polyp burden in patients with iron deficiency anaemia (IDA), and to extrapolate these findings to assess FIT’s utility in predicting the likelihood of conversion from CCE to conventional colonoscopy (CCC) based on underlying pathology in IDA.
The CLEAR IDA study was a multicentre, retrospective observational study conducted across four UK hospitals. Data were collected over a six-month study period and included patients referred via the two-week-wait (2WW) cancer pathway for iron deficiency, with or without anaemia, over a 12-month timeframe. Colonoscopy findings were analysed and extrapolated using NHS England’s CCE-to-colonoscopy referral criteria to assess the predictive value of FIT for colorectal cancer (CRC), polyp burden, and CCC using ROC curve analysis. The optimal FIT threshold was identified through three complementary approaches: threshold-based analysis, decision curve analysis, and cost-benefit modelling.

Results

A total of 1,531 patients were analysed; only 1.6% underwent small bowel capsule endoscopy. The diagnostic accuracy (AUC) of FIT for predicting CRC, polypoidal lesions, and CCC was 0.78, 0.58, and 0.69, respectively. Threshold-based analysis identified FIT = 15 µg/g as the lowest level at which CCC rates significantly increased (p = 0.02; OR = 1.87; 95% CI: 1.07–3.14). Decision curve analysis showed maximum net benefit at FIT = 17.6 µg/g, while cost-benefit modelling identified 9 µg/g as the most cost-effective. An optimal cost-effective FIT threshold range was identified between 10 and 17.6 µg/g. Threshold selection should be tailored to local service capacity and resource availability.

Conclusion

Significant pathologies in the IDA pathway were uncommon. A FIT threshold range between 10–17 µg/g may enhance cost-effectiveness and guide appropriate PCE use in IDA.

References

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