ASGE Endoscopy Course at ACG: Everyday Endoscopy: Expertise Meets Evidence | October 2024-23_Shaukat_My Top 5 Tips for polypectomy for the busy gastroenterologist

23_Shaukat_My Top 5 Tips for polypectomy for the busy gastroenterologist

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Dr. Aasma Shaukat offers guidance for gastroenterologists performing polypectomies. Her top five tips focus on crucial aspects, including inspection techniques, recognizing expertise boundaries, submucosal injection strategies, underwater endoscopic mucosal resection (EMR), and post-resection treatment.<br /><br />**1. Inspection:** This initial step involves using classification systems such as Paris and NICE to determine the extent of submucosal invasion or potential malignancy. White light and narrow-band imaging help assess features, including pit patterns and non-lifting signs, crucial for devising a resection strategy.<br /><br />**2. Knowing Your Expertise:** It's important to assess your ability to perform the resection safely before proceeding. If needed, consult with or refer to a colleague experienced in advanced techniques. Tattoo placement and proper documentation are essential for identifying lesion sites and minimizing complications from submucosal fibrosis.<br /><br />**3. Submucosal Injection Solutions:** Dr. Shaukat advises using reliable solutions like saline mixed with methylene blue or indigo carmine for better submucosal lift, while considering proprietary agents based on cost-effectiveness and performance.<br /><br />**4. Underwater EMR:** This technique offers benefits such as clearer visualization and cost efficiency by using water rather than air or CO2 for distending the lumen. It provides better separation of the mucosa from the muscularis propria, facilitating safer and larger en bloc resections.<br /><br />**5. Treat the edges:** Ensure complete removal by managing the edges of the resected area, potentially using techniques like clip closure for improved healing.<br /><br />Concluding, Dr. Shaukat emphasizes the Cold Snare Polypectomy (CSP) as a preferred method for polyps sized under 19 mm due to its safety and efficacy. Performing thorough lesion assessment, knowing one's limits, and following correct surveillance intervals are crucial steps in successful polypectomy outcomes.

Keywords

gastroenterology

polypectomy

inspection techniques

expertise boundaries

submucosal injection

underwater EMR

post-resection treatment

Cold Snare Polypectomy

lesion assessment

resection strategy