Advertisement

Colonoscopic Polypectomy

  • Chang Kyun Lee
  • Sung Noh Hong
Chapter

Abstract

All neoplastic colorectal polyps, even small/diminutive lesions, would do well to be removed because their malignant potential is never known before adequate pathologic evaluation. Colonoscopic polypectomy (CPP) is the most commonly performed therapeutic procedure during colonoscopy. CPP techniques have evolved substantially in recent years. Various equipment and techniques are now available for different clinical settings. Prior to CPP, endoscopists need to consider the natural history of individual lesions, the age and comorbidity of the patient, and risks of intervention, while patients should understand benefits and risks of CPP, including consequences of perforation and bleeding. Endoscopists should select appropriate technique based on polyp size, morphological characteristics, and position of the polyp within the colon. Tiny polyp (1–3 mm) can be removed by using forceps from anywhere in the colon (cold forceps polypectomy). Diminutive polyps (≤5 mm) can be removed not only by cold forceps polypectomy but also cold snare polypectomy. Small polyps (6–9 mm) are best removed by cold snaring, hot snaring, or endoscopic mucosal resection (EMR) technique. Large polyps (≥10 mm) may be removed by standard hot snaring. However, EMR is growing in popularity and probably safer than hot snaring, especially when removing lesions from the right colon. The endoscopist should aim to perform en bloc resection at a single snaring, but endoscopic piecemeal mucosal resection or endoscopic submucosal dissection should be considered for sessile lesions ≥2 cm.

References

  1. 1.
    Arnold M, Sierra MS, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global patterns and trends in colorectal cancer incidence and mortality. Gut. 2017;66(4):683–91.CrossRefGoogle Scholar
  2. 2.
    Winawer SJ, Zauber AG, Ho MN, O’Brien MJ, Gottlieb LS, Sternberg SS, et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med. 1993;329(27):1977–81.CrossRefGoogle Scholar
  3. 3.
    Zauber AG, Winawer SJ, O’Brien MJ, Lansdorp-Vogelaar I, van Ballegooijen M, Hankey BF, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med. 2012;366(8):687–96.CrossRefGoogle Scholar
  4. 4.
    Pohl H, Srivastava A, Bensen SP, Anderson P, Rothstein RI, Gordon SR, et al. Incomplete polyp resection during colonoscopy-results of the complete adenoma resection (CARE) study. Gastroenterology. 2013;144(1):74–80.e1.CrossRefGoogle Scholar
  5. 5.
    Hewett DG. Cold snare polypectomy: optimizing technique and technology (with videos). Gastrointest Endosc. 2015;82(4):693–6.CrossRefGoogle Scholar
  6. 6.
    Chan FKL, Goh KL, Reddy N, Fujimoto K, Ho KY, Hokimoto S, et al. Management of patients on antithrombotic agents undergoing emergency and elective endoscopy: joint Asian Pacific Association of Gastroenterology (APAGE) and Asian Pacific Society for Digestive Endoscopy (APSDE) practice guidelines. Gut. 2018;67(3):405–17.CrossRefGoogle Scholar
  7. 7.
    Acosta RD, Abraham NS, Chandrasekhara V, Chathadi KV, Early DS, Eloubeidi MA, et al. The management of antithrombotic agents for patients undergoing GI endoscopy. Gastrointest Endosc. 2016;83(1):3–16.CrossRefGoogle Scholar
  8. 8.
    Rey JF, Beilenhoff U, Neumann CS, Dumonceau JM. European Society of Gastrointestinal Endoscopy (ESGE) guideline: the use of electrosurgical units. Endoscopy. 2010;42(9):764–72.CrossRefGoogle Scholar
  9. 9.
    Lee CK, Shim JJ, Jang JY. Cold snare polypectomy vs. cold forceps polypectomy using double-biopsy technique for removal of diminutive colorectal polyps: a prospective randomized study. Am J Gastroenterol. 2013;108(10):1593–600.CrossRefGoogle Scholar
  10. 10.
    Vanagunas A, Jacob P, Vakil N. Adequacy of "hot biopsy" for the treatment of diminutive polyps: a prospective randomized trial. Am J Gastroenterol. 1989;84(4):383–5.PubMedGoogle Scholar
  11. 11.
    Wadas DD, Sanowski RA. Complications of the hot biopsy forceps technique. Gastrointest Endosc. 1988;34(1):32–7.CrossRefGoogle Scholar
  12. 12.
    Monkemuller KE, Fry LC, Jones BH, Wells C, Mikolaenko I, Eloubeidi M. Histological quality of polyps resected using the cold versus hot biopsy technique. Endoscopy. 2004;36(5):432–6.CrossRefGoogle Scholar
  13. 13.
    Lee SH, Shin SJ, Park DI, Kim SE, Jeon HJ, Kim SH, et al. Korean guideline for colonoscopic polypectomy. Clin Endosc. 2012;45(1):11–24.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Chang Kyun Lee
    • 1
  • Sung Noh Hong
    • 2
  1. 1.Department of Gastroenterology, Center for Crohn’s and ColitisKyung Hee University Hospital, Kyung Hee University School of MedicineSeoulSouth Korea
  2. 2.Department of Gastroenterology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea

Personalised recommendations