Vormbrock K, Mönkemüller K. Difficult colon polypectomy. World J Gastrointest Endosc 2012; 4(7): 269-280 [PMID: 22816006 DOI: 10.4253/wjge.v4.i7.269]
Corresponding Author of This Article
Klaus Mönkemüller, MD, PhD, FASGE, Division of Gastroenterology, Hepatology and Infectious Diseases, Marienhospital Bottrop, Josef- Albers-Str. 70, 46242 Bottrop, Germany. moenkemueller@yahoo.com
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Editorial
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World J Gastrointest Endosc. Jul 16, 2012; 4(7): 269-280 Published online Jul 16, 2012. doi: 10.4253/wjge.v4.i7.269
Table 1 Defintion of difficult colon polyp
Shape (morphology)
Flat or hard to see
Sessile > 15 mm
Carpet shaped (laterally spreading tumor)
Villous or granular
Irregular surface, irregular pit pattern, villous or granular
If pedunculated, thick or short pedicle
Size
< 1.5 cm
Large > 3 cm
Big head
Number
Multiple (> 3)
Location
Right colon and cecum
Ileoceccal valve
Appendix orifice
On top or behind of folds
Difficult endoscopic position
Table 2 Nine steps leading to a successful polypectomy
Locate of the polyp
Analyze the polyp’s shape
Determine the polyp’s size
Analysis of the polyp surface
Determine the number of polyps
Position the polyp before attempting its resection
Estimate polyp respectability using endoscopic methods
Use the submucosal cushion (injection-assisted-polypectomy)
Appropriate skills using clips and/or endoloops
Table 3 Accessories and utensils used in advanced polypectomy
Hot biopsy forceps (we do not recommend to use hot biopsy forceps for colon polyp removal)
Single use
Resusable
Monofilament and braided wire snares of various diameters, e.g. mini < 11 mm, standard 15-45 mm)
Mini oval (recommended to remove diminutive polyps using the cold-snare technique, i.e. without heat of electrosurgical current)
Standard oval
Hexagonal
Crescent
Spiral
Mini barbed (the multiple barbs (help hold the tissue inside of the snare)
Needle-tip anchored (the needle tip on top the distal part of the snare helps stabilize the position of the snare, however the tip can lacerate the healthy mucosa)
With heat- resistant net (Nakao net) (not widely available)