Colonoscopic Polypectomy

All neoplastic colorectal polyps, even small/diminutive lesions, would do well to be removed because their malignant potential is never known before adequate pathologic evaluation. Colonoscopic polypectomy (CPP) is the most commonly performed therapeutic procedure during colonoscopy. CPP techniques have evolved substantially in recent years. Various equipment and techniques are now available for different clinical settings. Prior to CPP, endoscopists need to consider the natural history of individual lesions, the age and comorbidity of the patient, and risks of intervention, while patients should understand benefits and risks of CPP, including consequences of perforation and bleeding. Endoscopists should select appropriate technique based on polyp size, morphological characteristics, and position of the polyp within the colon. Tiny polyp (1–3 mm) can be removed by using forceps from anywhere in the colon (cold forceps polypectomy). Diminutive polyps (≤5 mm) can be removed not only by cold forceps polypectomy but also cold snare polypectomy. Small polyps (6–9 mm) are best removed by cold snaring, hot snaring, or endoscopic mucosal resection (EMR) technique. Large polyps (≥10 mm) may be removed by standard hot snaring. However, EMR is growing in popularity and probably safer than hot snaring, especially when removing lesions from the right colon. The endoscopist should aim to perform en bloc resection at a single snaring, but endoscopic piecemeal mucosal resection or endoscopic submucosal dissection should be considered for sessile lesions ≥2 cm.