ASGE Postgraduate Course at ACG 2022: Expanding the Scope of Fundamental and Advanced Endoscopy | October 2022-6_Rastogi_Final version Selecting Polypectomy Technique based on Polyp Characteristic copy.pdf6_Rastogi_Final version Selecting Polypectomy Technique based on Polyp Characteristic

6_Rastogi_Final version Selecting Polypectomy Technique based on Polyp Characteristic copy.pdf6_Rastogi_Final version Selecting Polypectomy Technique based on Polyp Characteristic

Pdf Summary

Polypectomy is a procedure aimed at safely and efficiently removing polyps. The ideal way to assess advanced histology in polyps is through accurate and complete removal. Cold Snare Polypectomy (CSP) has limitations due to its lack of cautery and heat, which restricts the amount of tissue that can be cut and limits the depth of resection. The use of larger snares in CSP is not suitable for all polyps. <br /><br />Studies have compared the depth of resection in CSP with other techniques such as Endoscopic Mucosal Resection (EMR), Hot Snare Polypectomy (HSP), and Underwater EMR (UEMR). The findings show that EMR and HSP have better resection depth and higher rates of complete resection compared to CSP. CSP is not ideal for smaller polyps (<2 cm) suspected of advanced histology, as they require en bloc resection for accurate evaluation and prognostication.<br /><br />Lateral Spreading Tumors (LST) are a specific type of polyp that can be categorized into two types: granular and non-granular. The non-granular type has a higher chance of high-grade dysplasia and superficially invasive cancer. The dominant nodule of LST should be removed en bloc for separate pathology assessment.<br /><br />Surface assessment criteria can be used to predict the nature of polyps. The J NET classification helps identify polyps with high-grade dysplasia and superficially invasive cancer. SMI (Submucosal Invasion) and tumor budding are also criteria used to assess the extent of invasion.<br /><br />Cold Snare Piecemeal EMR is an effective technique for removing lesions ≥20 mm, particularly LST-granular and sessile serrated lesions (SSL). This technique has shown high efficacy and low recurrence rates when appropriate lesion selection is made.<br /><br />Selecting the appropriate polypectomy technique depends on polyp characteristics. For polyps <10 mm without signs of advanced histology, CSP is preferred. For larger polyps without advanced histology, CSP or HSP can be used. En bloc resection with techniques like EMR, UEMR, Hybrid ESD, or ESD is recommended for polyps ≥20 mm or with features of advanced histology. SSLs can be removed with CSP, while large pedunculated polyps require HSP. Lastly, for polyps with features of covert invasive cancer, EMR, UEMR, Hybrid ESD, or ESD should be used.

Keywords

Polypectomy

advanced histology

Cold Snare Polypectomy

Endoscopic Mucosal Resection

Hot Snare Polypectomy

Underwater EMR

Lateral Spreading Tumors

J NET classification

Submucosal Invasion

Cold Snare Piecemeal EMR