ASGE Postgraduate Course at ACG 2022: Expanding the Scope of Fundamental and Advanced Endoscopy | October 2022-Point Counterpoint: Selecting Polypectomy Technique Based on Polyp Characteristics

Point Counterpoint: Selecting Polypectomy Technique Based on Polyp Characteristics

Video Transcription

Video Summary

Dr. Amit Rastogi from the University of Kansas argues against the use of cold-snare polypectomy for certain types of polyps. He explains that the aim of a good polypectomy is to remove the entire polyp safely and efficiently, allowing for accurate histological interpretation. However, cold-snare polypectomy has limitations due to the lack of cautery and heat, resulting in a superficial resection plane and limited ability to remove large polyps. Dr. Rastogi presents data comparing cold-snare polypectomy with hot-snare EMR, showing that cold snare often does not remove submucosa or achieve histological complete remission. He asserts that for polyps suspected of having advanced histology, such as high-grade dysplasia or superficially invasive cancer, cold-snare polypectomy is not ideal. Instead, he recommends on-block resection using hot-snare polypectomy, EMR, underwater EMR, hybrid ESD, or ESD. Dr. Rastogi emphasizes the importance of considering polyp characteristics and using the appropriate polypectomy technique accordingly.

Asset Subtitle

Amit Rastogi, MD, FASGE

Keywords

cold-snare polypectomy

histological interpretation

hot-snare EMR

submucosa

advanced histology