Definition and Purpose of Polypectomy
Polypectomy is the endoscopic removal of polyps from the colon and rectum, with the primary aim of completely removing colorectal lesions to prevent colorectal cancer development. 1
Polypectomy is a fundamental skill for endoscopists performing colonoscopy and has been shown to reduce the risk of future colorectal cancer and advanced adenomas 2, 1.
Types of Polypectomy Techniques
The choice of polypectomy technique depends on several factors including polyp size, morphology, and location:
Cold snare polypectomy is recommended for diminutive (≤5 mm) and small (6-9 mm) lesions due to high complete resection rates and excellent safety profile 1
Hot snare polypectomy is recommended for pedunculated lesions >10 mm in size 1
Cold or hot snare polypectomy (with or without submucosal injection) is suggested for 10-19 mm non-pedunculated lesions 1
Endoscopic mucosal resection (EMR) is recommended for large (≥20 mm) non-pedunculated colorectal lesions 1
Cold forceps polypectomy is generally not recommended due to high rates of incomplete resection, though jumbo or large-capacity forceps may be considered for diminutive lesions ≤2 mm when cold snare is technically difficult 1
Hot biopsy forceps are not recommended due to high incomplete resection rates, inadequate histopathologic specimens, and higher complication rates 1
Polypectomy Procedure Considerations
Before performing polypectomy, several important steps should be taken:
A structured visual assessment using high-definition white light and/or electronic chromoendoscopy should be conducted for all polyps 1
Documentation of endoscopic descriptors including location, size in millimeters, and morphology in the colonoscopy procedure report is essential 1
Photo documentation is recommended for all lesions ≥10 mm in size before removal 1
For non-pedunculated adenomatous lesions ≥10 mm, surface morphology should be described as granular or non-granular lateral spreading lesions 1
Special Situations and Advanced Techniques
For more complex polyps:
Lifting agents or underwater endoscopic mucosal resection may be considered for removal of sessile polyps 10-19 mm in size 1
Serrated polyps should be resected using cold resection techniques, with submucosal injection potentially helpful for polyps >10 mm if margins cannot be well delineated 1
For large (≥20 mm) non-pedunculated colorectal lesions, referral to an endoscopist experienced in advanced polypectomy is recommended 1
Tattoo placement should be considered for lesions that may need future localization at endoscopy or surgery 1
Complications and Management
The two most common post-polypectomy complications are bleeding and perforation 3:
Clips are not routinely needed to close resection sites for polyps <20 mm 1
Proper understanding of the endoscopy suite's electrosurgical generator settings is important for polypectomy safety 1
Non-pedunculated polyps with clear evidence of submucosally invasive cancer should be referred for surgical evaluation rather than endoscopic removal 1, 4
Follow-up After Polypectomy
Surveillance intervals after polypectomy should be based on the findings at baseline colonoscopy:
The quality of the baseline examination is critical for effectively reducing colon cancer risk 1
Completeness of polypectomy at baseline is emphasized, particularly for piecemeal removal of large sessile polyps 1
Surveillance recommendations should be based on risk stratification according to the number, size, and histology of polyps removed 1