Masterclass Colonoscopy: Trends and Recommendations Forward (On-demand) | February 2024-Resection of small lesions, pedunculated SSLs

Resection of small lesions, pedunculated SSLs

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This document discusses various approaches to endoscopic resection in the colorectum, focusing on different types and sizes of lesions. For lesions that are 10 mm in size, the recommended approach is cold snare polypectomy. For lesions that are 3 mm in size, cold forceps (large capacity or jumbo) can be used. For submucosal superficial lesions (SSLs), hyperplastic polyps (HPs), and adenomas 10-20 mm in size, cold EMR or cold snare without injection is recommended. For adenomas larger than 20 mm, cold or hot EMR, ESD for select cases, or EMR/ESD plus FTRD can be used.<br /><br />The document also discusses the evaluation of the quality of resection. Studies have shown that the effectiveness and competency of resection can vary significantly. Polypectomy competency does not necessarily correlate with adenoma detection rate (ADR).<br /><br />A tool called the Cold Snare Polypectomy Assessment Tool (CSPAT) is introduced, which provides guidelines for performing cold snare polypectomy. It emphasizes placing the snare accurately, keeping a good working distance, and retrieving the specimen.<br /><br />The document also explores different techniques and approaches for cold snaring, including the use of thin wire or thick wire. It discusses the incomplete resection rate and compares the results between thin and thick wire.<br /><br />Extensions of cold resection, such as cold EMR and cold piecemeal EMR without injection, are discussed for SSLs and large serrated lesions.<br /><br />For adenomas 10-20 mm in size, there is limited data available. The document suggests using diathermy (EMR) for any suspicion of cancer, and it discusses various approaches based on the characteristics of the lesion (pedunculated, bulky, flat).<br /><br />Finally, the document presents a study on complete resection rates in 6-15 mm polyps, comparing cold snare, hot snare, cold EMR, and hot EMR. Incomplete resection rates are provided for each technique.<br /><br />Overall, the document provides a comprehensive overview of current approaches and techniques for endoscopic resection in the colorectum, highlighting the importance of complete resection and the need for further research in certain areas.

Keywords

endoscopic resection

colorectum

lesions

cold snare polypectomy

cold forceps

hyperplastic polyps

adenomas

Cold Snare Polypectomy Assessment Tool

thin wire

thick wire