Complex colon polypectomy

Abstract

By interrupting the adenoma-carcinoma sequence, endo-scopic polypectomy can prevent the development of colorectal cancer (CRC). Endoscopic polypectomy has, therefore, become an accepted screening and surveillance modality for CRC and has been widely adopted by clinicians, policymakers, and professional organizations as an effective screening tool. Most gastroenterologists are adequately trained to endoscopically excise the majority of polyps found in a routine colonoscopy. However, some polyps, due to their size, location, or configuration, are considered more technically challenging or are associated with an increased risk of complications (such as bleeding or perforation) and, hence, are not routinely resected. These so-called complex polypectomies are the focus of this paper.

Keywords: Colorectal neoplasia; colonoscopy; endoscopic mucosal resection; endoscopic submucosal dissection; postpolypectomy syndrome.

Figure 1

Successful en-bloc resection and retrieval of a large sessile polyp (A and B). Mucosal defect without bleeding or residual adenomatous tissue (C).

Figure 2

A pedunculated polyp with a thick stalk (A) that was successfully resected endoscopically (B). Endoclips were subsequently placed at the base of the polyp to prevent postpolypectomy bleeding (C).