Complicated Polypectomy

Before beginning polypectomy, the polyp should be evaluated for the possible presence of malignancy. Approaching the large and difficult colon polyp requires skill and patience. Properly trained endoscopic assistants must be present as well as all necessary equipment including the electrosurgical unit and a variety of ancillary therapeutic devices. Two major techniques that are used for removal of the difficult colon polyp are endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). EMR requires the repeated application of standard techniques ordinarily used for polypectomy, including submucosal injection and piecemeal resection of adenomatous tissue. ESD on the other hand involves electrocautery tunneling underneath the entire polyp with special tools, resulting in one large specimen. Both methods are effective for removal of sessile polyps. The technique of EMR is within the capability of any person who has learned the basic techniques of polypectomy since removal of large sessile neoplasms is only an extension of the skills requires to resect smaller polyps. ESD is a new and exciting development in the field of colon polypectomy where developments and tools and techniques are progressing rapidly.