ASGE Endo Hangout: Polypectomy Techniques | August 2026-Recorded webinar

Video Transcription

Video Summary

This ASGE Endo Hangout session on polypectomy techniques reviewed practical, case-based strategies for endoscopic resection of colon polyps. Dr. Dennis Yang and Dr. Ajaypal Singh emphasized that successful EMR starts with a clear plan: choose the injection strategy deliberately, use dynamic lifting to shape the lesion, avoid over-injecting, and resect systematically to avoid leaving islands of tissue. They highlighted the importance of a distal attachment cap for scope stability, better visualization, and hemostasis.<br /><br />The speakers compared cold versus hot EMR. Cold EMR was described as safer, with lower risks of bleeding and perforation, but potentially higher recurrence for adenomas, especially larger or fibrotic lesions. It was favored for serrated lesions and higher-bleeding-risk patients, while hot EMR may be preferred when deeper resection is needed or cancer is a concern. Margin ablation after EMR was presented as standard practice for reducing recurrence, with the key point that only the mucosal margin—not visible residual tissue—should be ablated.<br /><br />For pedunculated polyps, they reviewed bleeding-prevention options including endoloop/polyloop, clips, and epinephrine injection, and stressed that the main goal is a safe resection while preserving a clear deep margin. For fibrotic or previously manipulated polyps, they discussed underwater EMR, cap-assisted techniques, avulsion, hybrid ESD, and full-thickness resection as part of a broader toolkit.<br /><br />They also reviewed optical diagnosis and Paris classification to identify lesions at higher risk for superficial or deep submucosal invasion, where en bloc resection or ESD may be needed. The session concluded with practical advice on snare selection, prophylactic clip closure for large right-sided lesions, and thoughtful tattooing only when it will help future endoscopic or surgical management.

Keywords

polypectomy

endoscopic mucosal resection

colon polyps

cold EMR

hot EMR

margin ablation

pedunculated polyps

endoloop

fibrotic polyps

optical diagnosis

Paris classification

prophylactic clip closure