The ‘workhorse’ of GI & endoscopy: How advanced tools are driving efficiency and patient safety

Gastrointestinal and endoscopy practices are facing multiple challenges that negatively affect their bottom line — such as persistent anesthesiologist shortages, high staff turnover, rising patient demand and low reimbursement rates.

To address these challenges, GI facilities are constantly looking for tools and processes that improve clinical and operational efficiencies. Becker’s Hospital Review recently learned of two such innovations from experts in the field:

• Randall Meisner, MD, is a gastroenterologist at Corewell Health Butterworth Hospital (Grand Rapids, Mich.) who performs thousands of GI procedures each year. Dr. Meisner explained how cold snare polypectomy — the standard modality for removing small (≤ 10mm) colorectal polyps may help practices become more efficient and effective, by safely applying cold snaring to larger polyps as well. The cold snare technique is central to the design of the SnareMaster™ Plus snare, Olympus’ latest addition to its SnareMaster™ family of polypectomy tools.

• Patrick Romano, endoscopy business unit vice president at Olympus, detailed imaging technology that may aid in early polyp detection — Texture and Color Enhancement Imaging (TXI™) technology — as part of Olympus’ EVIS X1™ endoscopy system.¹ Romano explained how this tool can shorten the learning curve for endoscopists, while enhancing the quality of procedures.

Utilizing the cold snare technique more often can drive efficiency for busy GI practices

There are two main reasons why the cold snare technique may help GI practices improve efficiency and accelerate patient throughput. First, using this technique can shorten the average duration of polypectomy procedures that would otherwise be performed using hot snare, a resection technique that involves electrocauterization to remove harmful tissue and seal blood vessels. Because of its complexity, the hot snare method typically requires more time, effort and training compared to cold snare, while putting patients at an elevated risk of complications, particularly post-polypectomy bleeding. Patients who suffer complications may need to be readmitted.

“Where cold snare is of tremendous benefit is in patients who are on anticoagulation or who have coagulopathy and are at higher risk for bleeding,” Dr. Meisner said. “In my experience, the use of cold snare may significantly decrease those patients’ risk of bleeding and allow you to restart anticoagulation and prevent thromboembolic events sooner.”

Secondly, because the cold snare technique is simpler to perform, in Dr. Meisner’s experience, it requires less training for medical assistants and nursing staff. Such supportive roles are critical for GI practices, yet in the current environment, practices are experiencing extremely high rates of turnover. High turnover means GI facilities and practices are having to constantly commit time to training new staff.

“I can’t emphasize enough how important it is for a busy center like ours to have easy-to-use snare equipment,” Dr. Meisner said. “What your technicians and RNs feel comfortable using in a case is nearly as important as anything else. If they’re not comfortable with the snare, in this day and age of high turnover, that’s a huge problem. You need equipment that’s easy to use, easy to teach, easy to maneuver, that your staff likes more than other tools — and that’s also going to afford better quality. The SnareMaster™ Plus snare is by far the easiest to use and manipulate, in my opinion.”

Complementary innovation: imaging technology aiding polyp detection

The Texture and Color Enhancement Imaging (TXI™) technology in Olympus’ EVIS X1 endoscopy system enhances image color, texture and brightness, which may help physicians detect potentially suspicious lesions and polyps.²

“Users can see potential lesions that may not be visible under normal white light, due to enhancements in the image,” Mr. Romano said. “If we can reduce adenoma miss rates, for example, physicians can diagnose and treat patients right the first time. With enhanced visibility and more polyps being detected, the durability of a therapeutic instrument, like the SnareMaster™ Plus snare, to remove multiple polyps during one procedure becomes all the more important.”

The emphasized image information provided by TXI technology may shorten the learning curve for endoscopists, while enhancing the quality of procedures. “With TXI technology, it’s easy to see more with a less trained eye,” Mr. Romano said. “That may improve patient outcomes at outpatient centers that specialize in diagnostic procedures like screening colonoscopies.”

Perceived barriers to using cold snare are due to outdated beliefs and cultural resistance

In traditional GI practices, there may be beliefs that using the hot snare method leads to better results when removing polyps larger than 10mm or polyps that are flat. However, these beliefs are fading due to advances in technology, as the new generation of cold snares can remove polyps smaller than one centimeter. In addition, accumulating evidence of resection success with cold snares shows the advantages of this method.³

The other barrier to wider adoption of cold snaring is largely cultural, based on inertia and existing habits. As many people in healthcare may know, cultural change is notoriously challenging. “Change is difficult among endoscopists, especially those who’ve been practicing for a while,” Dr. Meisner said.

The SnareMaster™ Plus snare stands out to me for its durable build, hybrid nature and ease of use

Amid a variety of cold snare devices on the market, the SnareMaster™ Plus snare stands out due to its cold cutting ability, in Dr. Meisner’s experience. The SnareMaster™ Plus snare features⁴:

• Durability, which maintains loop stability and shape maintenance even after multiple cuts. Combined with the thinness of the wire (0.3mm), the stiffness of the device facilitates clean, sharp cold cutting. “I’ve found other cold snares lose their durability after multiple polyp resections,” Dr. Meisner said. “In my opinion, the SnareMaster™ Plus snare is the most durable, and I feel comfortable so that if I find 20 or 30 additional polyps in a procedure, it’s going to maintain its durability and I won’t have to switch to another snare — and that’s obviously cost-effective.”

• Hybrid hot and cold cutting ability, allowing the user to switch the device between modalities during a procedure, if the procedure calls for it. That capability, which Dr. Meisner said he uses several times each month, may help physicians perform large or complex polyp resections without having to exchange devices, which may reduce procedure time in cases where both hot and cold manipulation is needed and improving the overall efficiency of procedures for practices.

• Ease of use, thanks to its ability to go small or large and accommodate polyp sizes that may not require the full deployment of the snare. This is often the case when resecting polyps in the 3-5mm range. “The ease of use of the SnareMaster™ Plus snare is extremely important and why it is my preferred snare,” Dr. Meisner said.

• Hexagonal shape, which allows for manipulation and control when removing polyps, while allowing for an appropriate margin of normal tissue required for cold snare polypectomy.

• Multiple sizes (10mm and 15mm), to meet various clinical needs.

As a result of its versatile, user-centric build, the SnareMaster™ Plus snare also aids in positive patient outcomes, according to Dr. Meisner. For a polypectomy patient, the primary outcome of importance — besides polyp removal — is the absence of postprocedural bleeding. Post-polypectomy bleeding is particularly risky for patients who are at elevated risk of thrombosis, stroke or other cardiac events and are therefore on blood thinners, which need to be resumed soon after the polypectomy.

“Post-polypectomy bleeds can be a complication in large polyp resections,” Dr. Meisner said. “I don’t recall the last post-polypectomy bleed I’ve had, using the SnareMaster™ Plus snare.”

With innovation, SnareMaster™ Plus snare is addressing what matters most to gastroenterologists like Dr. Meisner. Ease of use is critical during this time of high employee turnover, as it decreases required training. The hybrid hot and cold capability may lessen the amount of time needed for a procedure and improve efficiency.

And, decreased bleeding can mean improved outcomes and faster healing, which is the focus of clinicians, as well as patients. That’s why Dr. Meisner sees the SnareMaster™ Plus snare as the gold standard: “In our center, it is by far the ‘workhorse snare’ — the snare that is effective and used in the highest percentage of polyps throughout the day.”

1. Data on file with Olympus (DC00489968).
2. Data on file with Olympus (DC00489968).
3. Schett B, Wallner J, Weingart V, Ayvaz A, Richter U, Stahl J, Allescher HD. “Efficacy and safety of cold snare resection in preventive screening colonoscopy,” Endosc Int Open. 2017 Jul;5(7):E580-E586. doi: 10.1055/s-0043-105491. Epub 2017 Jun 23. PMID: 28670614; PMCID: PMC5482746.

Disclaimer
Randall Meisner, MD is a paid consultant to Olympus Corporation, its subsidiaries and/or its affiliates. The positions and statements made herein by Dr. Randall Meisner are based on his experiences, thoughts and opinions. As with any product, results may vary and the techniques, instruments and settings can vary from facility to facility. You should thoroughly review the relevant user manual(s) for instructions, warnings, and cautions.

SnareMaster™ Plus Electrosurgical Snare Disclaimer
Do not use these instruments for any purpose other than their intended use as this could cause pa tient injury or damage to the instrument. Performing polypectomy within the GI tract is a technically demanding procedure and use of associated products such as the SnareMaster™ Plus electrosurgical snare may result in possible electrosurgical risks and patient injury to include, but are not limited to, infection, bleeding, perforation, and mucous membrane damage. When applied to a patient with a pacemaker implanted, the instrument or A cord may cause malfunctioning or failure of the pacemaker, seriously affecting the patient. Before proceeding, always confirm with a cardiologist or the manufacturer of the pacemaker that it is safe to proceed.

Evis X1™ Endoscopy System Disclaimer
TXI™ technology is not intended to replace histopathological sampling as a means of diagnosis. The EVIS X1™ endoscopy system is not designed for cardiac applications. Other combinations of equipment may cause ventricular fibrillation or seriously affect the cardiac function of the patient. Improper use of endoscopes may result in patient injury, infection, bleeding, and/or perforation.