Advanced Colon Polypectomy

In the United States colorectal cancer (CRC) is the second leading cause of death from cancer. Removal of colon adenomas is associated with a reduction in the incidence of CRC. Thus, CRC largely could be prevented by the detection and removal of adenomatous polyps.⁴ There are several methods to remove polyps by using either surgical or endoscopic methods. Standard polyp removal methods include the use of biopsy forceps and various types of electrocautery snares. Advanced polypectomy techniques are used to remove large, flat, atypical, or colon polyps located in difficult anatomic positions. Multimodal or advanced imaging techniques such as chromoendoscopy and virtual chromoendoscopy might be helpful in the characterization of polyps. Minor and major complications occur in about 10% of advanced polypectomies. Therefore, any physician attempting advanced polypectomy techniques should be an experienced colonoscopist and have adequate training in interventional endoscopy. The objective of this practical review is to present the principles, theory, and technique of advanced colon polypectomy.

Abbreviations used in this paper: APC, argon plasma coagulation, CRC, colorectal cancer, EMR, endoscopic mucosal resection, ESD, endoscopic submucosal dissection, ESG, electrosurgical generator, EVR, epinephrine volume reduction, IAP, injection-assisted polypectomy, LSP, laterally spreading polyps, NBI, narrow band imaging, NOTES, natural orifice transluminal endoscopic surgery