Endoscopic excision of pre-cancerous complex colon polyps: improving outcomes and developing new endoscopic instruments/techniques
File(s)
Author(s)
Tsiamoulos, Zacharias
Type
Thesis
Abstract
With improved access to colonoscopy services and the recent advent of the National Bowel Cancer Screening Programme, the number of complex polypectomies performed in the United Kingdom has increased significantly. Almost all complex pre-cancerous colon polyps can now be resected endoscopically, preceded by a thorough patient preparation and a careful lesion assessment. This thesis investigates the endoscopic management of complex colon polyps, including modifications to improve existing polypectomy techniques and the development of new endoscopic platforms and instruments. The thesis initially examines existing practice and includes a prospective audit of the short and long-term outcomes of piecemeal Endoscopic Mucosal resection (p-EMR) technique at a tertiary endoscopic centre. Several salvage modifications to the p-EMR technique, such as the addition of a cautious application of ablative modalities, are described to manage complex fibrotic
polyps. Post-polypectomy bleeding is the most common serious p-EMR complication and factors associated with bleeding risk along with the preclinical use of a new potential haemostatic and sealing agent are investigated.
En-bloc excision of complex colon polyps to ensure complete excision remains an important goal for the therapeutic endoscopist. A main body of the work in this thesis describes the development of a new device for endoscopic submucosal dissection (ESD) incorporating novel design and electrosurgical properties. The development of combined endoscopic/surgical platform is also described to improve access and facilitate the radical treatment of complex rectal polyps. Finally, to approach the management of complex colorectal polyps in a “holistic way”, a clinical service enhancement, the polyp multi-disciplinary meeting has been initiated and evaluated.
polyps. Post-polypectomy bleeding is the most common serious p-EMR complication and factors associated with bleeding risk along with the preclinical use of a new potential haemostatic and sealing agent are investigated.
En-bloc excision of complex colon polyps to ensure complete excision remains an important goal for the therapeutic endoscopist. A main body of the work in this thesis describes the development of a new device for endoscopic submucosal dissection (ESD) incorporating novel design and electrosurgical properties. The development of combined endoscopic/surgical platform is also described to improve access and facilitate the radical treatment of complex rectal polyps. Finally, to approach the management of complex colorectal polyps in a “holistic way”, a clinical service enhancement, the polyp multi-disciplinary meeting has been initiated and evaluated.
Version
Open Access
Date Issued
2021-05-31
Date Awarded
01/07/2025
License URL
Advisor
Saunders, Brian
Hart, Ailsa
Faiz, Omar
Publisher Department
Department of Surgery & Cancer
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Medicine (Research) MD (Res)