Evaluation of the multifunctional BOWA ARC HF-generator for polypectomy, mucosal resection (EMR) and submucosal dissection (ESD) at the lower GI-tract

Fragestellung:

Endoscopic resections (ER) at the lower GI tract may be classified as simple polypectomy (< 25 mm size, PE), advanced polypectomy (> 25 mm, aPE) or specialised polypectomy (> 25 mm, requiring further techniques, loop etc, sPE) and ER of flat mucosal lesions (EMR, piece meal) or submucosal dissection (ESD).

Ziel:

This study reports on the efficacy and safety of these resection types using the multifunctional ARC HF generator (BOWA electronic, Gomaringen, Germany) in 219 pts referred for colorectal ER. After initial evaluation of the HF generator following results were obtained from 5 endoscopists for PE, aPE, sPE, EMR and ESD:

Type	number lesions	size [mm]	program [W]	coagulation [effect 1 – 7]	resection velocity (F = fast, M = medium, S = slow)
PE:	N = 131	12.8+7	CutPol 18+12	4+2	22 (17%) F, 109 (83%) M
aPE:	N = 41	38.3+13	CutPol 22+15	3+2	11 (27%) F, 30 (73%) M
sPE:	N = 7	34.6+46	CutPol 20+5	5+2	7 (100%) M
EMR:	N = 31	24.1+12	CutPol 15+21	2.5+2	28 (90%) F, 3 (10%) M
ESD:	N = 9	41.8+37	CutPap 18+10	3+1	8 (89%) F, 1 (11%) M

Methodik:

Bleeding requiring treatment occurred during PE in 2 (1.5%), aPE in 2 (4.8%, 5 clips), EMR in 2 pts (6.4%, 10 clips, APC). 24h after resection 2pts (6.4%) had post-polypectomy bleeding. 1 covered perforation occurred during ESD. 4 major complications were recorded (1.8%).

Ergebnis:

ER using the ARC HF generator for various lesions (5 – 65 mm) was found to be similarly effective and safe compared to other HF devices. Polypoid lesions were mostly resected during M velocity with coagulation of 3 – 4, while flat lesions in EMR/ESD were resected in F technique with coagulation of 2.5.