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Update on Difficult Polypectomy Techniques

  • Large Intestine (B Cash, Section Editor)
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Abstract

Endoscopists often encounter colon polyps that are technically difficult to resect. These lesions traditionally were managed surgically, with significant potential morbidity and mortality. Recent advances in endoscopic techniques and instruments have allowed endoscopists to safely and effectively remove colorectal lesions with high technical and clinical success and potentially avoid invasive surgery. Endoscopic mucosal resection (EMR) has gained acceptance as the first-line therapy for large colorectal lesions. Endoscopic submucosal dissection (ESD) has been reported to be associated with higher rate of en bloc resection and less risk of short-time recurrence, but with an increased risk of adverse events. Therefore, the role of colorectal ESD should be restricted to lesions with high-risk morphologic features of submucosal invasion. In this article, we review the recent literature on the endoscopic management of difficult colorectal neoplasms.

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Abbreviations

APC:

Argon plasma coagulation

EMR:

Endoscopic mucosal resection

ESD:

Endoscopic submucosal dissection

IBD:

Inflammatory bowel disease

LSTs:

Laterally spreading tumors

OR:

Odds ratio

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, 1800 Orleans Street, Zayed Bldg, Suite 7125B, Baltimore, MD, 21287, USA

    Saowanee Ngamruengphong, Yamile Haito-Chavez & Mouen A. Khashab

  2. Department of Gastroenterology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA

    Heiko Pohl

  3. Department of Gastroenterology, VA Medical Center White River Junction, White River Junction, VT, USA

    Heiko Pohl

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  1. Saowanee Ngamruengphong
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Saowanee Ngamruengphong and Yamile Haito-Chavez declare that they have no conflicts of interest. Heiko Pohl reports personal fees from Interscope, outside the submitted work. Mouen A. Khashab is a consultant for Boston Scientific and Olympus.

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Ngamruengphong, S., Pohl, H., Haito-Chavez, Y. et al. Update on Difficult Polypectomy Techniques. Curr Gastroenterol Rep 18, 3 (2016). https://doi.org/10.1007/s11894-015-0476-7

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