Digestive Diseases and Sciences

, Volume 57, Issue 7, pp 1786–1791 | Cite as

Quality of Polyp Resection During Colonoscopy: Are We Achieving Polyp Clearance?

  • Shanglei Liu
  • Samuel B. Ho
  • Mary Lee Krinsky
Original Article


Background and Study Aim

Currently colonoscopy quality indicators emphasize our ability to improve polyp detection (e.g., preparation quality, withdrawal times of ≥6 min). The completeness of a polyp resection may also be an important determinant of quality and efficient colonoscopy. The primary aim of this study was to determine the incidence of an incomplete polyp resection despite a perceived complete polypectomy.

Patients and Methods

This was a retrospective quality assurance project conducted at the San Diego Veterans Affair Medical Center and University of California San Diego Medical Center from July 2007 to April 2008. The patients recruited to this study were undergoing surveillance and screening colonoscopy. The resection quality was evaluated in 65 polyps of 47 patients. Twenty-two polyps were removed with standard biopsy forceps, jumbo forceps (18), hot snare (18), and cold snare (7). Biopsies were taken from the post-polypectomy site base and perimeter for histologic examination in order to confirm histologic absence of all polypoid appearing mucosa.


The post-polypectomy sites of ten polyps (15 %) were found to have residual polypoid tissue. Six were removed by standard biopsy forceps, jumbo forceps (2), hot snare (1), and cold snare (1). When compared to other polypectomy devices, standard biopsy forceps were more likely to result in an incomplete resection (27 vs. 9 %; P = 0.076).


The endoscopist may not be visually accurate in determining when a polyp is completely resected, and alternative devices and techniques for polyp resection should be considered.


Colorectal neoplasia Colon cancer screening Polypectomy Colonoscopy Biopsy forcep Snare 



The authors wish to thank Dana Riley and Rohit Loomba, MD for the assistance in the preparation and review of this manuscript.

Conflict of interest

Dr. Mary Lee Krinsky has received an unrestricted educational grant from Spectrascience at the time of this study.


  1. 1.
    Caputi BO, Ugenti I, Martines G, et al. Endoscopic management of large colorectal polyps. Int J Colorectal Dis. 2009;24:749–753.CrossRefGoogle Scholar
  2. 2.
    Levin B, Lieberman DA, 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. CA Cancer J Clin. 2008;58:130–160.PubMedCrossRefGoogle Scholar
  3. 3.
    Rex DK. Colonoscopic withdrawal technique is associated with adenoma miss rates. Gastrointest Endosc. 2000;51:33–36.PubMedCrossRefGoogle Scholar
  4. 4.
    Harewood GC, Sharma VK, de Garmo P. Impact of colonoscopy preparation quality on detection of suspected colonic neoplasia. Gastrointest Endosc. 2003;58:76–79.PubMedCrossRefGoogle Scholar
  5. 5.
    Rex DK, Petrini JL, Baron TH, et al. Quality indicators for colonoscopy. Am J Gastroenterol. 2006;101:873–885.PubMedGoogle Scholar
  6. 6.
    Barclay RL, Vicari JJ, Doughty AS, et al. Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med. 2006;355:2533–2541.PubMedCrossRefGoogle Scholar
  7. 7.
    Lai EJ, Calderwood AH, Doros G, et al. The Boston bowel preparation scale: a valid and reliable instrument for colonoscopy-oriented research. Gastrointest Endosc. 2009;69:620–625.PubMedCrossRefGoogle Scholar
  8. 8.
    Sung HY, Cheung DY, Cho SH, et al. Polyps in the gastrointestinal tract: discrepancy between endoscopic forceps and resected specimens. Eur J Gastroenterol Hepatol. 2009;21:190–195.PubMedCrossRefGoogle Scholar
  9. 9.
    Singh N, Harrison M, Rex DK. A survey of colonoscopic polypectomy practices among clinical gastroenterologists. Gastrointest Endosc. 2004;60:414–418.PubMedCrossRefGoogle Scholar
  10. 10.
    Kimmey MB, Silverstein FE, Saunders DR, Haggitt RC. Endoscopic bipolar forceps: a potential treatment for the diminutive polyp. Gastrointest Endosc. 1988;34:38–41.PubMedCrossRefGoogle Scholar
  11. 11.
    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.PubMedGoogle Scholar
  12. 12.
    Efthymiou M, Taylor ACF, Desmond PV, et al. Biopsy forceps is inadequate for the resection of diminutive polyps. Endoscopy. 2011;43:312–316.PubMedCrossRefGoogle Scholar
  13. 13.
    Woods A, Sanowski RA, Wadas DD, et al. Eradication of diminutive polyps: a prospective evaluation of bipolar coagulation versus conventional biopsy removal. Gastrointest Endosc. 1989;35:536–540.PubMedCrossRefGoogle Scholar
  14. 14.
    Binmoeller KF, Bohnacker S, Seifert H, et al. Endoscopic snare excision of “giant” colorectal polyps. Gastrointest Endosc. 1996;43:183–188.PubMedCrossRefGoogle Scholar
  15. 15.
    van Rijn JC, Reitsma JB, Stoker J, et al. Polyp miss rate determined by tandem colonoscopy: a systematic review. Am J Gastroenterol. 2006;101:343–350.PubMedCrossRefGoogle Scholar
  16. 16.
    Rex DK, Cutler CS, Lemmel GT, et al. Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies. Gastroenterology. 1997;112:24–28.PubMedCrossRefGoogle Scholar
  17. 17.
    Monkemuller K, Neumann H, Malfertheiner P, Fry LC. Advanced colon polypectomy. Clin Gastroenterol Hepatol. 2009;7:641–652.PubMedCrossRefGoogle Scholar
  18. 18.
    McAfee JH, Katon RM. Tiny snares prove safe and effective for removal of diminutive colorectal polyps. Gastrointest Endosc. 1994;40:301–303.PubMedCrossRefGoogle Scholar
  19. 19.
    Rex DK. Colonoscopic polypectomy. Rev Gastroenterol Disord. 2005;5:115–125.PubMedGoogle Scholar
  20. 20.
    Tappero G, Gaia E, De Giuli P, et al. Cold snare excision of small colorectal polyps. Gastrointest Endosc. 1992;38:310–313.PubMedCrossRefGoogle Scholar
  21. 21.
    Farrar WD, Sawhney MS, Nelson DB, et al. Colorectal cancers found after a complete colonoscopy. Clin Gastroenterol Hepatol. 2006;4:1259–1264.PubMedCrossRefGoogle Scholar
  22. 22.
    Robertson DJ, Greenberg ER, Beach M, et al. Colorectal cancer in patients under close colonoscopic surveillance. Gastroenterology. 2005;129:34–41.PubMedCrossRefGoogle Scholar
  23. 23.
    Pabby A, Schoen RE, Weissfeld JL, et al. Analysis of colorectal cancer occurrence during surveillance colonoscopy in the dietary Polyp Prevention Trial. Gastrointest Endosc. 2005;61:385–391.PubMedCrossRefGoogle Scholar
  24. 24.
    Deenadayalu VP, Rex DK. Colon polyp retrieval after cold snaring. Gastrointest Endosc. 2005;62:253–256.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC (Outside the USA) 2012

Authors and Affiliations

  • Shanglei Liu
    • 1
  • Samuel B. Ho
    • 1
  • Mary Lee Krinsky
    • 1
  1. 1.Gastroenterology (111D), Department of MedicineVA San Diego Healthcare System and University of California, San DiegoSan DiegoUSA

Personalised recommendations