ASGE Postgraduate Course at ACG 2022: Expanding the Scope of Fundamental and Advanced Endoscopy | October 2022-6 Rastogi_Selecting Polypectomy Technique based on Polyp Characteristic

6 Rastogi_Selecting Polypectomy Technique based on Polyp Characteristic

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When selecting a polypectomy technique based on polyp characteristics, several factors should be considered. For polyps smaller than 10 mm with no endoscopic evidence of advanced histology, cold snare polypectomy (CSP) is typically sufficient. For polyps sized 10-19 mm without evidence of advanced histology, CSP or hot snare polypectomy (HSP) can be used. However, if these polyps exhibit features of advanced histology, en bloc resection should be performed using techniques such as HSP, endoscopic mucosal resection (EMR), underwater EMR (UEMR), hybrid endoscopic submucosal dissection (ESD), or ESD. For sessile serrated lesions (SSL), regardless of size, CSP is the preferred technique. For large pedunculated polyps larger than 10 mm, HSP is recommended.<br /><br />For polyps 20 mm or larger with a Paris Type IIa or Lateral Spreading Tumor (LST) - granular morphology and NICE type 2 assessment, CSP or EMR can be used. However, if the polyps show features of covert invasive cancer, such as an absence of overt endoscopic features, size of 20 mm or larger, rectosigmoid location, dominant sessile nodule, or JNET 2b or Kudo Vi classification, en bloc resection using EMR, UEMR, hybrid ESD, or ESD is necessary.<br /><br />It's important to note that CSP has limitations, including the lack of cautery and heat, which limits the amount of tissue that can be cut and the depth of resection. CSP is not ideal for polyps smaller than 2 cm with suspected advanced histology. En bloc resection is preferred for accurate prognostication and clear margins.<br /><br />Overall, the selection of the polypectomy technique should be based on the size, characteristics, and risk factors of the polyp to ensure complete and safe removal.

Keywords

polypectomy technique

polyp characteristics

CSP

HSP

EMR

UEMR

hybrid ESD

sessile serrated lesions

covert invasive cancer

complete removal