ASGE Postgraduate Course at ACG 2022: Expanding the Scope of Fundamental and Advanced Endoscopy (On-Demand) | 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

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In this document, Dr. Amit Rastogi discusses the selection of polypectomy techniques based on the characteristics of polyps. The aim of polypectomy is to completely, safely, and efficiently remove polyps for accurate histological assessment. The limitations of Cold Snare Polypectomy (CSP) are discussed, including its inability to cut a large amount of tissue and its superficial resection plane. CSP is not ideal for all polyps, especially those with advanced histology.<br /><br />The depth of resection for different types of polyps is also examined. Studies comparing CSP to other techniques such as Hot Snare Polypectomy (HSP) and Underwater EMR (UEMR) show that CSP is associated with a higher risk of unevaluable or positive margins and a shallower resection depth. For non-pedunculated polyps, HSP and UEMR result in higher rates of en bloc resection, complete resection, and histologic complete resection compared to CSP.<br /><br />The document also discusses the clinical implications of polypectomy techniques. CSP is not recommended for polyps smaller than 2 cm with suspicion of advanced histology. En bloc resection is preferred for clear margins and prognostication. The Paris Classification and Lateral Spreading Tumors are mentioned as important factors in determining the appropriate technique for polypectomy.<br /><br />The document summarizes various studies on cold snare piecemeal EMR for lesions of at least 20 mm, showing its efficacy and low recurrence rates when appropriate lesion selection is made. Cold Snare EMR for larger lesions also shows high rates of complete resection, with advanced histology and a modest recurrence rate.<br /><br />Overall, the selection of the polypectomy technique depends on the size and characteristics of the polyp, with options including CSP, HSP, EMR, UEMR, Hybrid ESD, and ESD. The document emphasizes the importance of choosing the appropriate technique to achieve complete and safe polyp removal.

Keywords

polypectomy techniques

characteristics of polyps

histological assessment

Cold Snare Polypectomy

limitations of CSP

depth of resection

Hot Snare Polypectomy

Underwater EMR

clinical implications

Paris Classification