Clinical Endoscopy

Original Articles

Depth of noninjecting resection using bipolar soft coagulation mode for 6 to 9 mm colorectal polyps: a retrospective study in Japan: Yoshifumi Watanabe, Mitsuo Tokuhara, Hidetoshi Nakata, Hiroko Nakahira, Ikuko Torii, Yasumasa Sumitomo; Clin Endosc 2026;59(1):115-123. Published online December 18, 2025; DOI: https://doi.org/10.5946/ce.2025.100

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Endoscopic resection of colorectal polyps reduces mortality from colorectal cancer. We report here a novel resection method, known as noninjecting resection using bipolar soft coagulation mode (NIRBS), and assess its feasibility. This study aimed to compare the resection depth achieved with NIRBS to those achieved with cold snare polypectomy (CSP) and conventional endoscopic mucosal resection (CEMR).
Methods
Patients with 6 to 9 mm colorectal polyps underwent endoscopic resection at Hoshigaoka Medical Center between October 2023 and January 2024. We analyzed the thickness of resected submucosal tissue following the use of NIRBS, CSP, and CEMR.
Results
We identified 95 polyps, including adenomas and serrated lesions. The proportions of specimens containing submucosal tissue were 21.4%, 100.0%, and 97.9% in CSP, CEMR, and NIRBS, respectively. The median submucosal tissue thickness for CEMR and NIRBS was 1,167 and 1,125 µm, respectively, which was significantly greater than 0 µm for CSP. For NIRBS, the median thickness was 1,140 and 1,017 µm for the expert and non-expert endoscopists, respectively.
Conclusions
The depth of submucosal resection with NIRBS exceeded 1,000 μm regardless of endoscopist experience. NIRBS can be a useful resection method for patients with colorectal polyps, including those with non-submucosally invasive carcinomas.

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Evaluation of a new method, “non-injection resection using bipolar soft coagulation mode (NIRBS)”, for colonic adenomatous lesions: Mitsuo Tokuhara, Masaaki Shimatani, Kazunari Tominaga, Hiroko Nakahira, Takuya Ohtsu, Katsuyasu Kouda, Makoto Naganuma; Clin Endosc 2023;56(5):623-632. Published online May 18, 2023; DOI: https://doi.org/10.5946/ce.2022.200

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: Endoscopic resection of all colorectal adenomatous lesions with a low complication rate, simplicity, and negative residuals is challenging. Hence, we developed a new method called “non-injection resection using bipolar soft coagulation mode (NIRBS)” method, adapted for colorectal lesions. In addition, we evaluated the effectiveness of this method.
Methods
We performed NIRBS throughout a 12-month period for all colorectal lesions which snare resection was acceptable without cancerous lesions infiltrating deeper than the submucosal layer.
Results
A total of 746 resected lesions were included in the study, with a 4.5 mm mean size (range, 1–35 mm). The major pathological breakdowns were as follows: 64.3% (480/746) were adenomas, and 5.0% (37/746) were intraepithelial adenocarcinomas (Tis lesions). No residuals were observed in any of the 37 Tis lesions (mean size, 15.3 mm). Adverse events included bleeding (0.4%) but no perforation.
Conclusions
NIRBS allowed the resection of multiple lesions with simplicity because of the non-injection and without perforating due to the minimal burn effect of the bipolar snare set in the soft coagulation mode. Therefore, NIRBS can be used to resect adenomatous lesions easily, including Tis lesions, from small to large lesions without leaving residuals.

Citations

Citations to this article as recorded by

Depth of noninjecting resection using bipolar soft coagulation mode for 6 to 9 mm colorectal polyps: a retrospective study in Japan
Yoshifumi Watanabe, Mitsuo Tokuhara, Hidetoshi Nakata, Hiroko Nakahira, Ikuko Torii, Yasumasa Sumitomo
Clinical Endoscopy.2026; 59(1): 115. CrossRef
International Digestive Endoscopy Network consensus on the management of antithrombotic agents in patients undergoing gastrointestinal endoscopy
Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
Clinical Endoscopy.2024; 57(2): 141. CrossRef
IDEN Consensus on Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy
Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
The Korean Journal of Gastroenterology.2024; 83(6): 217. CrossRef
International Digestive Endoscopy Network Consensus on the Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy
Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
Gut and Liver.2024; 18(5): 764. CrossRef
A method of “Noninjecting Resection using Bipolar Soft coagulation mode; NIRBS” for superficial non-ampullary duodenal epithelial tumor: a pilot study
Mitsuo Tokuhara, Yasushi Sano, Yoshifumi Watanabe, Hidetoshi Nakata, Hiroko Nakahira, Shingo Furukawa, Takuya Ohtsu, Naohiro Nakamura, Takashi Ito, Ikuko Torii, Takeshi Yamashina, Masaaki Shimatani, Makoto Naganuma
BMC Gastroenterology.2024;[Epub] CrossRef

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