Complicated Polypectomy

Training in removal of colorectal polyps requires the achievement of proficiency in handling of the colonoscope and knowledge of all the various techniques associated with polypectomy including when and how to use electrocautery, types of snares, hemostasis, and injection methods. When possible, complicated polypectomy should be performed in the morning. This allows for adequate post-procedure monitoring prior to discharge. The endoscopist and nursing staff must be aware of, and be familiar with, the available endoscopes, electrosurgical generator, snares, and auxiliary equipment. Safety in snare polypectomy can be enhanced by using the snare handle as an information system. A complementary resection modality to endoscopic mucosal resection is endoscopic submucosal dissection (ESD), which was originally developed in Japan. ESD allows removal of a large sessile lesion in one piece by injecting fluid into the submucosa, and dissecting underneath the lesion with an electrosurgical knife until the resection is complete.