ASGE Endoscopy Course at ACG: Everyday Endoscopy: Expertise Meets Evidence | October 2024-20_Kahi_Know your polyp recognizing margins and selecting the right approach

20_Kahi_Know your polyp recognizing margins and selecting the right approach

Pdf Summary

The document outlines best practices and recent research in the field of polypectomy, focusing primarily on colorectal polyps. Dr. Charles J. Kahi introduces why high-quality polypectomy is critical, highlighting that incomplete resections are associated with a higher risk of subsequent neoplasia and up to 15% of Post-Colonoscopy Colorectal Cancers (PCCRC).<br /><br />Key classifications are discussed, including the Paris Endoscopic and NICE classifications, which assist in determining the correct approach to polyp removal. Identifying submucosal invasive cancer (SMIC) features is crucial in decision-making. Features such as the non-lifting sign and specific visual classifications suggest deeper invasion, influencing treatment choices.<br /><br />For the majority of polyps ( 10 mm), cold snare polypectomy (CSP) is recommended due to its safety profile. Research comparing cold and hot snare techniques shows CSP to be associated with lower complications like post-polypectomy bleeding, though with a slightly higher recurrence rate. Intermediate-sized polyps (10-19 mm) require more individualized strategies based on features like histology and location.<br /><br />The document emphasizes the importance of selecting between cold and hot snare polypectomies and Endoscopic Mucosal Resection (EMR) based on polyp size, susceptibility to cancer, and patient factors. Particularly for sessile serrated lesions (SSLs), cold techniques are preferred due to safety.<br /><br />Pedunculated polyps, even with deeper invasive features, can generally be managed endoscopically with specific techniques to ensure en bloc resections.<br /><br />Overall, the text urges practitioners to tailor each approach considering the polyp's characteristics and patient conditions, stressing the significance of assessing SMIC features and managing serrated lesion margins attentively. The takeaway is that polypectomy techniques have evolved from art to science, demanding careful and informed decision-making.

Keywords

polypectomy

colorectal polyps

incomplete resections

Post-Colonoscopy Colorectal Cancers

Paris Endoscopic classification

NICE classification

submucosal invasive cancer

cold snare polypectomy

Endoscopic Mucosal Resection

sessile serrated lesions