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

6 Rastogi_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 the polyp for accurate assessment of advanced histology, if present.<br /><br />The document highlights the limitations of Cold Snare Polypectomy (CSP), which include the lack of cautery and heat that limits the amount of tissue that can be cut and the superficial plane of resection. It also mentions that CSP is not ideal for all polyps, especially those larger than 9 mm or with suspicion of advanced histology.<br /><br />Different studies are presented that compare the depth of resection and outcomes of different techniques. It is found that CSP is associated with a higher risk of procedure-related unevaluable or positive margins compared to other techniques like Endoscopic Mucosal Resection (EMR) or Hot Snare Polypectomy (HSP).<br /><br />The document also discusses the importance of en bloc resection with as much submucosa as possible for clear vertical margins and normal mucosa around the lesion for accurate prognostication. It suggests that en bloc resection by techniques like HSP, EMR, Underwater EMR (UEMR), Hybrid ESD, or ESD would be the preferred method even for smaller lesions.<br /><br />The document further discusses the characteristics and management of Lateral Spreading Tumors (LSTs) and introduces various classification systems, including the Paris Classification and the J NET Classification.<br /><br />Different studies on Cold Snare Piecemeal EMR for lesions larger than 20 mm are presented, showing high efficacy and low recurrence rates when appropriate lesion selection is performed.<br /><br />Efficiency and time taken for removing large bulky sessile lesions with cold snares are also mentioned, comparing them to larger snares used for other techniques.<br /><br />Lastly, the document provides recommendations for selecting polypectomy techniques based on the size and characteristics of the polyps, emphasizing the importance of considering endoscopic evidence of advanced histology and the use of en bloc resection for larger or suspicious lesions.

Keywords

polypectomy techniques

characteristics of polyps

advanced histology

Cold Snare Polypectomy

limitations of CSP

Endoscopic Mucosal Resection

Hot Snare Polypectomy

en bloc resection

Lateral Spreading Tumors

Paris Classification