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A Pragmatic Approach to Complex Colon Polyps

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Gastrointestinal Interventional Endoscopy

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Abstract

Endoscopic resection (ER) of complex colon polyps is safe and effective. Techniques of ER include endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). The majority of polyps encountered have low risk of submucosal invasion (SMI) and thus are suitably treated by EMR. Polyps with increased risk of superficial SMI are best removed en bloc as this allows accurate staging and potential cure. Polyps with suspected superficial SMI that are ≤20 mm in size are resectable by EMR, but larger lesions require resection by ESD. Polyps with obvious SMI, such as depressed lesions with disrupted surface pit pattern, require surgical resection. This chapter discusses endoscopic assessment of large colonic polyps, technical aspects of EMR and ESD and techniques to prevent and manage ER-related complications.

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Abbreviations

CAST:

Cold-forceps avulsion with adjuvant snare tip soft coagulation

CSP:

Cold snare polypectomy

CSPEB:

Clinically significant post-endoscopy bleeding

DMI:

Deep mural injury

EMR:

Endoscopic mucosal resection

ER:

Endoscopic resection

ESD:

Endoscopic submucosal dissection

FICE:

Flexible spectral imaging colour enhancement

GIT:

Gastrointestinal tract

ICV:

Ileocaecal valve

IPB:

Intra-procedural bleeding

LSL:

Laterally spreading lesion

MP:

Muscularis propria

NBI:

Narrow band imaging

NICE:

NBI International Colorectal Endoscopic

OR:

Odds ratio

SMF:

Submucosal fibrosis

SMI:

Submucosal invasion

SSP:

Sessile serrated polyp

STSC:

Snare tip soft coagulation

TS:

Target sign

TSC:

Topical submucosal chromoendoscopy

TTS:

Through the scope

UEMR:

Underwater endoscopic mucosal resection

WLE:

White light endoscopy

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Author information

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, NSW, Australia

    Michael X. Ma & Michael J. Bourke

  2. University of Sydney, Sydney, NSW, Australia

    Michael J. Bourke

Authors
  1. Michael X. Ma
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  2. Michael J. Bourke
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Correspondence to Michael J. Bourke .

Editor information

Editors and Affiliations

  1. Interventional Endoscopy, Division of Gastroenterology, University of Colorado-Denver, Aurora, CO, USA

    Mihir S. Wagh

  2. Interventional Endoscopy, Division of Gastroenterology, University of Colorado-Denver, Aurora, CO, USA

    Sachin B. Wani

Electronic Supplementary Material

This video demonstrates the technique of dynamic submucosal injection and snare placement to optimise resection. A small bleeding arteriole is seen within the resected defect and is treated by snare tip soft coagulation (MP4 67918 kb)

This video demonstrates use of snare tip soft coagulation (STSC) to treat intra-procedural bleeding (IPB) during EMR (MP4 39826 kb)

This video demonstrates the technique of piecemeal EMR by defect edge as the starting point for the subsequent snare resections of a large LSL (MP4 18036 kb)

This video demonstrates the technique of cold-forceps avulsion with adjuvant snare tip soft coagulation (CAST) to remove small residual adenomatous islands within an EMR defect (MP4 38447 kb)

This video demonstrates the technique of snare tip soft coagulation (STSC) to the EMR margin to reduce the risk of adenomatous recurrence (MP4 32012 kb)

This video demonstrates a type IV DMI (perforation) within a clean resection field. Two clips are placed over this defect. The EMR procedure is completed following satisfactory closure of the perforation (MP4 66126 kb)

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Ma, M.X., Bourke, M.J. (2020). A Pragmatic Approach to Complex Colon Polyps. In: Wagh, M., Wani, S. (eds) Gastrointestinal Interventional Endoscopy. Springer, Cham. https://doi.org/10.1007/978-3-030-21695-5_4

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  • DOI: https://doi.org/10.1007/978-3-030-21695-5_4

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