Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastrointest Endosc. Jul 16, 2012; 4(7): 269-280
Published online Jul 16, 2012. doi: 10.4253/wjge.v4.i7.269
Difficult colon polypectomy
Klaus Vormbrock, Klaus Mönkemüller
Klaus Vormbrock, Klaus Mönkemüller, Department of Internal Medicine, Gastroenterology and Infectious Diseases, Marienhospital Bottrop, 46242 Bottrop, Germany
Klaus Mönkemüller, Division of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, 15003 Magdeburg, Germany
Author contributions: Vormbrock K and Monkemuller K made substantial contributions to the conception and design, literature search, acquisition of data and photograph collection, analysis and interpretation of data; Vormbrock K drafted the manuscript and final approved the version to be published; Monkemuller K revised and corrected the manuscript for final critical intellectual content.
Correspondence to: Klaus Mönkemüller, MD, PhD, FASGE, Division of Gastroenterology, Hepatology and Infectious Diseases, Marienhospital Bottrop, Josef- Albers-Str. 70, 46242 Bottrop, Germany. moenkemueller@yahoo.com
Telephone: +49-2041-1061001 Fax: +49-2041-10161019
Received: September 15, 2011
Revised: June 14, 2012
Accepted: July 1, 2012
Published online: July 16, 2012

Colorectal cancer (CRC) is one of the leading causes of death from cancer in the world. We now know that 90% of CRC develop from adenomatous polyps. Polypectomy of colon adenomas leads to a significant reduction in the incidence of CRC. At present most of the polyps are removed endoscopically. The vast majority of colorectal polyps identified at colonoscopy are small and do not pose a significant challenge for resection to an appropriately trained and skilled endoscopist. Advanced polypectomy techniques are intended for the removal of difficult colon polyps. We have defined a “difficult polyp” as any lesion that due to its size, shape or location represents a challenge for the colonoscopist to remove. Although many “difficult polyps” will be an easy target for the advanced endoscopist, polyps that are larger than 15 mm, have a large pedicle, are flat and extended, are difficult to see or are located in the cecum or any angulated portion of the colon should be always considered difficult. Although very successful, advanced resection techniques can potentially cause serious, even life-threatening complications. Moreover, post polypectomy complications are more common in the presence of difficult polyps. Therefore, any endoscopist attempting advanced polypectomy techniques should be adequately supervised by an expert or have an excellent training in interventional endoscopy. This review describes several useful tips and tricks to deal with difficult polyps.

Keywords: Colonoscopy, Polypectomy, Mucosectomy, Colon polyp, Polyp, Endoscopic mucosal resection, Mucosectomy, Endoscopic submucosal dissection