ASGE Masterclass: Expert Performance Approach to Colonoscopy (On-Demand) | February 2026-Polyp Diagnosis and Management

Video Transcription

Video Summary

The speaker explains how to assess colorectal polyps/flat lesions during colonoscopy and choose an optimal removal method. Key decisions include whether snaring is appropriate, whether to use cold snare vs electrocautery (hot snare), and when en bloc resection is needed—mainly to accurately stage suspected early cancer (especially depth of submucosal invasion, with “superficial” defined as <1 mm and favorable histology potentially cured endoscopically).<br /><br />Cold snaring is presented as the modern “workhorse” because it markedly reduces delayed bleeding, post-coagulation syndrome, and perforation risk; large cold resection defects generally should not be clipped, even in most patients restarting DOACs. Hot snaring cuts deeper, helps with bulky tissue or fibrosis, but increases complications and often prompts clip closure.<br /><br />Cold snare is recommended for essentially all lesions ≤10 mm (including small pedunculated polyps), many 10–20 mm flat adenomas, and most sessile serrated lesions (SSLs) even when large, often via cold EMR (with or without injection). Overuse of cold snare is cautioned when cancer risk is higher: bulky/nodular or depressed lesions, rectal lesions, thick-stalk pedunculated polyps, and fibrotic recurrences—where electrocautery and/or en bloc techniques (e.g., ESD, especially in the rectum) may be preferred. Surveillance intervals after piecemeal resection are discussed (commonly 6 months for ≥20 mm adenomas; SSLs may be 6–12 months).

Keywords

colonoscopy polypectomy

colorectal polyps flat lesions assessment

cold snare resection

hot snare electrocautery

endoscopic mucosal resection (EMR)

endoscopic submucosal dissection (ESD) en bloc resection

sessile serrated lesions (SSL)

post-polypectomy surveillance interval