![]() Coloring dye can assist in both the delineation of polyp margins and identification of the submucosal plane ( Video 1, available online at The coloring dye may also help to identify residual polyp after endoscopic resection and improve recognition of perforations. Newer agents for submucosal injection use a combination of a viscous agent to maintain elevation and a coloring dye such as methylene blue or indigo carmine. 14, 15, 16 Epinephrine has been used for submucosal injection to prevent postpolypectomy bleeding. ![]() 11 A variety of injectable substances including dextrose 50%, glycerol, succinylated gelatin, methylcellulose, hyaluronic acid, fibrinogen, and hydroxyethyl starch have been evaluated for ease of injection and duration of submucosal lift. However, disadvantages to saline solution include rapid dispersion into neighboring tissue planes and clear color. 13 Saline solution is commonly used because of its low cost and wide availability. 4, 11, 12 Submucosal solutions are usually delivered with 21- to 25-gauge needles, with more viscous injectates requiring larger-bore needles. Submucosal injection is used to lift the target lesion to facilitate polyp removal and create separation between the mucosal resection surface and deeper layers of the bowel wall to minimize the risk of deep thermal injury, bleeding, and perforation. Snare modifications have been designed to facilitate grasping of flat polyps, including varying snare sizes, shapes, wire thickness, and wire configuration ( Table 1). Rotatable snares allow for rotation of the wire loop to the desired orientation relative to the targeted tissue. Certain newer snares have been designed without a monopolar electrode solely for the use of CSP for small polyps. ![]() However, snares can be used without electrocautery, relying solely on mechanical cutting as the snare is closed, also referred to as cold snare polypectomy (CSP). Tissue is thereby transected using mechanical and electrosurgical cutting as the snare is closed and withdrawn into a plastic insulating catheter, also referred to as hot snare polypectomy (HSP). Most polypectomy snares incorporate a monopolar wire loop electrode that allows for use with electrocautery. Polypectomy snares are designed to entrap targeted tissue for resection and are made of monofilament or braided wires of various shapes, lengths, gauges, and stiffness. Technology Status Evaluation Reports are not rules and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment or payment for such treatment. Technology Status Evaluation Reports are scientific reviews provided solely for educational and informational purposes. For this review, the MEDLINE database was searched through March 2020 for articles related to polypectomy and colonoscopy crossed with snare, bipolar snare, detachable snares, biopsy, hot biopsy, forceps, submucosal injection, mucosal resection cap, and hemoclip, among others. When financial guidance is indicated, the most recent coding data and list prices at the time of publication are provided. Technology Status Evaluation Reports are drafted by 1 or 2 members of the American Society for Gastrointestinal Endoscopy Technology Committee, reviewed and edited by the committee as a whole, and approved by the Governing Board of the American Society for Gastrointestinal Endoscopy. Technical data are gathered from traditional and Web-based publications, proprietary publications, and informal communications with pertinent vendors. ![]() In such cases, large case series, preliminary clinical studies, and expert opinions are used. Controlled clinical trials are emphasized, but in many cases data from randomized, controlled trials are lacking. Both are supplemented by accessing the “related articles” feature of PubMed and by scrutinizing pertinent references cited by the identified studies. Food and Drug Administration Center for Devices and Radiological Health) database search to identify the reported adverse events of a given technology. Evidence-based methodology is used, with a MEDLINE literature search to identify pertinent clinical studies on the topic and a MAUDE (U.S. The American Society for Gastrointestinal Endoscopy Technology Committee provides reviews of existing, new, or emerging endoscopic technologies that have an impact on the practice of GI endoscopy. ![]()
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