Why Endoscopic Tissue Resection?

More cost-effective procedures are what the market is increasingly looking for as hospitals face increased pressure and demands on ever more limited resource. Improvements in screening techniques have resulted in the potential to resect larger lesions with endoscopy. Technological innovations mean more diseases and conditions can now be treated than ever before but there has not been a corresponding increase in hospital budgets to keep up with demand. Procedures that can be carried out without an inpatient stay are more efficient and productive for all concerned.

Endoscopic resection could prevent 1 in 4 colorectal surgeries with a safe outpatient procedure¹.

The economic case for ETR 

When treating complex colon polyps, endoscopic tissue resection (ETR) has shown to be an efficacious and cost-effective treatment, even though many patients are still referred for surgical resection because of concerns over procedural safety and incomplete polyp resection.

The effectiveness of ETR is driven by high technical success and low adverse event rates compared with surgery.

On the other hand, the fewer adverse events associated with ETR are associated with markedly lower costs than surgical resection.

Endoscopic mucosal resection (EMR) has gained wide acceptance as a therapeutic option for various gastrointestinal lesions because it offers the advantage of providing an accurate local staging of the disease.³

EMR is particularly useful in managing large sessile and flat lesions of the colorectum. The most-common major complication is delayed bleeding, which usually occurs from 1 to 7 days after the patient is discharged from the endoscopic unit and represents an economic burden on health systems.⁴ Managing this risk with prophylactic clipping can provide hospitals costs savings.

Cost-effectiveness of hemostatic clips   

The use of  hemostatic clips to close the mucosal defect is a common prophylactic measure to prevent delayed bleeding⁴ and is cost effective in certain patients at high risk of bleeding.⁶  

Although clips represent a further cost during EMR, meta-analysis has shown that clip closure of a mucosal defect after EMR prevents bleeding in patients with large nonpedunculated colorectal polyps.⁷

In selected patients with a high risk of delayed hemorrhage, the prophylactic clipping after resection of large colon lesions is cost effective and even cost saving.⁶

1. Peery A. et al. Increasing Rates of Surgery for Patients With Nonmalignant Colorectal Polyps in the United States. Gastroenterology. Jan 2018. doi: 10.1053/j.gastro.2018.01.003

2. Keswani et al. Adverse events after surgery for nonmalignant colon polyps are common and associated with increased length of stay and costs. Gastrointest Endosc 2016 Aug;84(2):296-303.e1. https://pubmed.ncbi.nlm.nih.gov/26828760/ 

3. Hoffman A et al. Endoscopic Resection Techniques. Visc Med 2017;33:285-294 https://www.karger.com/Article/Fulltext/477923 

4. Spadaccini M, Albeniz E, Pohl H, et al. Prophylactic clipping after colorectal endoscopic resection prevents bleeding of large, proximal polyps: Meta-analysis of randomized trials. Gastroenterology 2020; 159(1):148–58.e11. 

5. Albeniz, Eduardo et al. Clip Closure After Resection of Large Colorectal Lesions With Substantial Risk of Bleeding. Gasteroenterology. Doi: 10.1053/j.gastro.2019.07.037. Epub 2019 Jul 27. 

6. Albeniz, Eduardo et al. The Answer to “When to Clip” After Colorectal Endoscopic Mucosal Resection Based on a Cost-Effectiveness Analysis. Endoscopy 

7. Spadaccini M, Albeniz E, Pohl H, et al. Prophylactic clipping after colorectal endoscopic resection prevents bleeding of large, proximal polyps: Meta-analysis of randomized trials. Gastroenterology 2020; 159(1):148–58.e11.