Polypectomy Techniques for Pedunculated and Nonpedunculated Polyps

Abstract

Colonoscopic polypectomy, when performed appropriately and completely, reduces subsequent risk of colorectal cancer. However, performance of high-quality polypectomy varies widely among endoscopists based on many factors, from exposure during fellowship to continuing education once in practice. Thus, this review is intended for a wide audience, from gastroenterology trainees to practicing physicians. A review of electrosurgery principles is included to cover effective polypectomy techniques and to prevent and troubleshoot problems.

Similarly, successful colon polypectomy is heavily dependent on both anatomic position and endoscopic clock-face position within the colon. As a result, both equipment choice and hand technique are discussed, and specific tips are offered to maximize the likelihood of success. Additionally, within this review, we highlight several of the latest advances within the field of polypectomy, such as submucosal injection (including choice of fluid), dynamic injection technique, a thorough discussion on hot vs cold snare, site management, and complication management. Lastly, we explore why incomplete polypectomy occurs, the implications of incomplete polypectomy, and methods to reduce this risk.