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DOI: 10.1055/s-0029-1215294
© Georg Thieme Verlag KG Stuttgart · New York
The suction pseudopolyp technique: a novel method for the removal of small flat nonpolypoid lesions of the colon and rectum
Publication History
submitted 18 March 2009
accepted after revision 4 August 2009
Publication Date:
06 November 2009 (online)
![](https://www.thieme-connect.de/media/endoscopy/200912/lookinside/thumbnails/10.1055-s-0029-1215294-1.jpg)
Background and study aims: Small flat nonpolypoid lesions of the colorectum can be technically difficult to target and completely remove; techniques such as hot biopsy forceps electrocauterization are associated with serositis, delayed bleeding, and perforation. This study aimed to describe a novel technique for the removal of such lesions and demonstrate its safety and efficacy.
Patients and methods: Patients aged 18 – 80 years with flat nonpolypoid lesions (Paris-Japanese classification 0-IIa and 0-IIb, measuring less than 10 mm) identified at colonoscopy were included in this prospective study. The lesions were removed by the suction pseudopolyp technique (SPT): the lesion is aspirated into the suction channel of the colonoscope and continuous suction applied for 5 seconds whilst the colonoscope is gently retracted. On release of the suction, the resulting pseudopolyp containing the lesion and a margin of normal tissue is easily ensnared and resected. The primary outcomes were endoscopic completeness of polyp resection and complication rate.
Results: Over a 12-month period, 1231 polyps were removed during 2656 colonoscopies; 126 polyps (in 101 patients) met inclusion criteria. Complete endoscopic resection was achieved in 100 % of the polyps, without immediate or delayed complication. Of the resected lesions, 57 % had malignant potential (adenomas 47 % and sessile serrated lesions 10 %); a higher proportion of lesions removed from the right colon had malignant potential compared with those from the left colon (75 % vs. 41 %, P = 0.0066).
Conclusions: Diminutive flat lesions of the colorectum are predominantly adenomas and sessile serrated lesions. SPT is a safe, effective, and reproducible therapy for removal of these lesions.
References
- 1 Kudo S, Lambert R, Allen J I. et al . Nonpolypoid neoplastic lesions of the colorectal mucosa. Gastrointest Endosc. 2008; 68 S3-47
- 2 Soetikno R M, Kaltenbach T, Rouse R V. et al . Prevalence of nonpolypoid (flat and depressed) colorectal neoplasms in asymptomatic and symptomatic adults. JAMA. 2008; 299 1027-1035
- 3 Waye J D. Techniques of polypectomy: hot biopsy forceps and snare polypectomy. Am J Gastroenterol. 1987; 82 615-618
- 4 Wadas D D, Sanowski R A. Complications of the hot biopsy forceps technique. Gastrointest Endosc. 1988; 34 32-37
- 5 Ho S B, Krinsky M L. Quality Polyp Resection in Colonoscopy: Are We Achieving Polyp Clearance?. Gastrointest Endosc. 2008; 67 AB79-AB80
- 6 Savides T J, See J A, Jensen D M. et al . Randomized controlled study of injury in the canine right colon from simultaneous biopsy and coagulation with different hot biopsy forceps. Gastrointest Endosc. 1995; 42 573-578
- 7 Singh N, Harrison M, Rex D K. A survey of colonoscopic polypectomy practices among clinical gastroenterologists. Gastrointest Endosc. 2004; 60 414-418
- 8 Winawer S J, Zauber A G, Ho M N. et al . Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med. 1993; 329 1977-1981
- 9 Rex D K. Have we defined best colonoscopic polypectomy practice in the United States?. Clin Gastroenterol Hepatol. 2007; 5 674-677
- 10 Levin T R, Zhao W, Conell C. et al . Complications of colonoscopy in an integrated health care delivery system. Ann Intern Med. 2006; 145 880-886
- 11 Rembacken B J, Fujii T, Cairns A. et al . Flat and depressed colonic neoplasms: a prospective study of 1000 colonoscopies in the UK. Lancet. 2000; 355 1211-1214
- 12 Tsuda S, Veress B, Toth E, Fork F T. Flat and depressed colorectal tumours in a southern Swedish population: a prospective chromoendoscopic and histopathological study. Gut. 2002; 51 550-555
- 13 Hurlstone D P, Cross S S, Adam I. et al . A prospective clinicopathological and endoscopic evaluation of flat and depressed colorectal lesions in the United Kingdom. Am J Gastroenterol. 2003; 98 2543-2549
- 14 The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc. 2003; 58 (Suppl. 6) S3-S43
- 15 Higuchi T, Sugihara K, Jass J R. Demographic and pathological characteristics of serrated polyps of colorectum. Histopathology. 2005; 47 32-40
- 16 Spring K J, Zhao Z Z, Karamatic R. et al . High prevalence of sessile serrated adenomas with BRAF mutations: a prospective study of patients undergoing colonoscopy. Gastroenterology. 2006; 131 1400-1407
- 17 Tappero G, Gaia E, De Giuli P. et al . Cold snare excision of small colorectal polyps. Gastrointest Endosc. 1992; 38 310-313
- 18 Van Gossum A, Cozzoli A, Adler M. et al . Colonoscopic snare polypectomy: analysis of 1485 resections comparing two types of current. Gastrointest Endosc. 1992; 38 472-475
- 19 Parra-Blanco A, Kaminaga N, Kojima T. et al . Colonoscopic polypectomy with cutting current: is it safe?. Gastrointest Endosc. 2000; 51 676-681
- 20 Levine D S, Haggitt R C. Normal histology of the colon. Am J Surg Pathol. 1989; 13 966-984
- 21 Vanagunas A, Jacob P, Vakil N. Adequacy of ”hot biopsy” for the treatment of diminutive polyps: a prospective randomized trial. Am J Gastroenterol. 1989; 84 383-385
- 22 Peluso F, Goldner F. Follow-up of hot biopsy forceps treatment of diminutive colonic polyps. Gastrointest Endosc. 1991; 37 604-606
- 23 Efthymiou M, Chen R, Taylor A, Desmond P. Assessing the efficacy of cold biopsy forceps polypectomy for diminutive polyps. Gastrointest Endosc. 2009; 69 AB108
- 24 Pabby A, Schoen R E, Weissfeld J L. et al . Analysis of colorectal cancer occurrence during surveillance colonoscopy in the dietary Polyp Prevention Trial. Gastrointest Endosc. 2005; 61 385-391
- 25 Farrar W D, Sawhney M S, Nelson D B. et al . Colorectal cancers found after a complete colonoscopy. Clin Gastroenterol Hepatol. 2006; 4 1259-1264
- 26 Goldstein N S, Watts J C, Neill J S. et al . The effect of electrothermal cautery-assisted resection of diminutive colonic polyps on histopathologic diagnosis. Am J Clin Pathol. 2001; 115 356-361
- 27 Rex D K, Alikhan M, Cummings O, Ulbright T M. Accuracy of pathologic interpretation of colorectal polyps by general pathologists in community practice. Gastrointest Endosc. 1999; 50 468-474
- 28 Atkin W S, Saunders B P. Surveillance guidelines after removal of colorectal adenomatous polyps. Gut. 2002; 51 (Suppl. 5) V6-V9
- 29 Winawer S J, Zauber A G, Fletcher R H. et al . Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society. Gastroenterology. 2006; 130 1872-1885
- 30 Mulder S A, Ouwendijk R J, van Leerdam M E. et al . A nationwide survey evaluating adherence to guidelines for follow-up after polypectomy or treatment for colorectal cancer. J Clin Gastroenterol. 2008; 42 487-492
- 31 Levin B, Lieberman D A, McFarland B. et al . Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology. 2008; 134 1570-1595
- 32 Hayes S J. Assessment of colorectal adenomatous polyp size measured during pathological examination highlights the importance of accuracy. Gastrointest Endosc. 2009; 70 540-541
- 33 Laiyemo A O, Murphy G, Albert P S. et al . Postpolypectomy colonoscopy surveillance guidelines: predictive accuracy for advanced adenoma at 4 years. Ann Intern Med. 2008; 148 419-426
- 34 Imperiale T F, Sox H C. Guidelines for surveillance intervals after polypectomy: coping with the evidence. Ann Intern Med. 2008; 148 477-479
M. J. BourkeMB BS
Department of Gastroenterology and Hepatology
Westmead Hospital
Hawkesbury Rd, Westmead NSW 2145
Sydney
Australia
Fax: +61-2-96333958
Email: michael@citywestgastro.com.au