Endoscopic mucosal resection (EMR) for large colorectal adenomatous lesions is hampered by a relevant risk of post-EMR delayed bleeding [1] [2]. Patients who have proximal lesions and/or are on antithrombotic treatment are at higher risk for such delayed bleeding [3].

Post-EMR prophylactic vessel coagulation has been previously standardized as the application of a low-voltage current using hemostatic forceps [4]. However, this requires a time-consuming device exchange, as well as an additional cost. In addition, the application of a low-voltage current by a relatively large forceps may result in deep thermal injury.

A recent peroral endoscopic myotomy-based series reported that a high-voltage coagulation current delivered through a dedicated knife in a saline-immersion setting maximizes the coagulation effect, preventing unintentional cutting of the vessel wall [5].

We present the case of an 84-year-old woman who underwent an underwater piecemeal EMR (Captivator II, 15 mm; Boston Scientific, Marlborough, Massachusetts, USA) for a large (50 mm) right colon laterally spreading tumor granular-type without endoscopic features of submucosal invasive cancer. To prevent delayed bleeding, prophylactic saline-immersion coagulation was performed at the end of the procedure ([Video 1]).

The snare tip was gently placed in contact with the visible vessels and a high-voltage coagulation current (ForcedCOAG E4.0, ERBE VIO3; ERBE Elektromedizin GmbH, Tübingen, Germany) was delivered. This resulted in progressive presealing of the vessels without any cutting effect ([Fig. 1]). The patient was discharged 4 hours after the procedure with no relevant post-procedural symptoms. No delayed bleeding or other adverse events were reported up to 30 days after the procedure.

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Article published online:
28 November 2024

© 2024. The Author(s). This article was originally published by Thieme in Endoscopy 2024; 56: E622–E623 as an open access article under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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