Skip to main content
SpringerLink
Log in
Book cover

The ASCRS Textbook of Colon and Rectal Surgery pp 79–91Cite as

Endoscopic Management of Polyps, Polypectomy, and Combined Endoscopic and Laparoscopic Surgery

  • Chapter
  • First Online:

  • 66k Accesses

Abstract

Polypectomy is fundamental to the practice of colonoscopy. Polypectomy disrupts the adenoma to carcinoma sequence, thereby reducing colorectal cancer incidence and mortality. The goals of polypectomy are the effective, safe, and efficient removal of precancerous polyps while minimizing the risk of complications. Recent advances in endoscopic techniques such as endoscopic mucosal resection and endoscopic submucosal dissection can ensure complete and safe resection of lesions and evade surgery in some patients. Combined endo-laparoscopic surgery is an adjunct to endoscopic polypectomy that may help to avoid colectomy. Although polyp removal using these advanced techniques may be an effective alternative in select patients, they require both experience and expertise to become an available option in a surgeon’s armamentarium.

This is a preview of subscription content, log in via an institution.

References

  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65(1):5–29.

    Google Scholar 

  2. Edwards BK, Ward E, Kohler BA, et al. Annual report to the nation on the status of cancer, 1975–2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer. 2010;116(3):544–73.

    PubMed  Google Scholar 

  3. Centers for Disease Control and Prevention. National Center for Health Statistics. National heath interview surveys 2000, 2013. public use data files. Updated 2014.

    Google Scholar 

  4. Zauber AG, Winawer SJ, O’Brien MJ, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med. 2012;366(8):687–96.

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Baker SL, Miller RA, Creighton A, Aguilar PS. Effect of 6-minute colonoscopy withdrawal time policy on polyp detection rate in a community hospital. Gastroenterol Nurs. 2015;38(2):96–9.

    Google Scholar 

  6. Baxter NN, Sutradhar R, Forbes SS, Paszat LF, Saskin R, Rabeneck L. Analysis of administrative data finds endoscopist quality measures associated with postcolonoscopy colorectal cancer. Gastroenterology. 2011;140(1):65–72.

    PubMed  Google Scholar 

  7. Lieberman DA, Weiss DG, Bond JH, Ahnen DJ, Garewal H, Chejfec G. Use of colonoscopy to screen asymptomatic adults for colorectal cancer. veterans affairs cooperative study group 380. N Engl J Med. 2000;343(3):162–8.

    CAS  PubMed  Google Scholar 

  8. Rathgaber SW, Wick TM. Colonoscopy completion and complication rates in a community gastroenterology practice. Gastrointest Endosc. 2006;64(4):556–62.

    PubMed  Google Scholar 

  9. Rex DK, Bond JH, Winawer S, et al. Quality in the technical performance of colonoscopy and the continuous quality improvement process for colonoscopy: recommendations of the U.S. multi-society task force on colorectal cancer. Am J Gastroenterol. 2002;97(6):1296–308.

    PubMed  Google Scholar 

  10. Barclay RL, Vicari JJ, Doughty AS, Johanson JF, Greenlaw RL. Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med. 2006;355(24):2533–41.

    CAS  PubMed  Google Scholar 

  11. Corley DA, Jensen CD, Marks AR, et al. Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med. 2014;370(14):1298–306.

    CAS  PubMed  PubMed Central  Google Scholar 

  12. Rex DK, Schoenfeld PS, Cohen J, et al. Quality indicators for colonoscopy. Gastrointest Endosc. 2015;81(1):31–53.

    Google Scholar 

  13. Chapuis PH, Dent OF, Goulston KJ. Clinical accuracy in the diagnosis of small polyps using the flexible fiberoptic sigmoidoscope. Dis Colon Rectum. 1982;25(7):669–72.

    CAS  PubMed  Google Scholar 

  14. Neale AV, Demers RY, Budev H, Scott RO. Physician accuracy in diagnosing colorectal polyps. Dis Colon Rectum. 1987;30(4):247–50.

    CAS  PubMed  Google Scholar 

  15. Bujanda L, Cosme A, Gil I, Arenas-Mirave JI. Malignant colorectal polyps. World J Gastroenterol. 2010;16(25):3103–11.

    PubMed  PubMed Central  Google Scholar 

  16. Molatore S, Ranzani GN. Genetics of colorectal polyps. Tech Coloproctol. 2004;8 Suppl 2:s240–2.

    PubMed  Google Scholar 

  17. Gschwantler M, Kriwanek S, Langner E, et al. High-grade dysplasia and invasive carcinoma in colorectal adenomas: a multivariate analysis of the impact of adenoma and patient characteristics. Eur J Gastroenterol Hepatol. 2002;14(2):183–8.

    PubMed  Google Scholar 

  18. Kulling D, Christ AD, Karaaslan N, Fried M, Bauerfeind P. Is histological investigation of polyps always necessary? Endoscopy. 2001;33(5):428–32.

    CAS  PubMed  Google Scholar 

  19. Church J. Polyp treatment. In: Endoscopy of the colon, rectum and anus. 1st ed. Japan: Igaku-Shoin; 1995. p. 156–78.

    Google Scholar 

  20. Lee SW, Garrett KA, Shin JH, Trencheva K, Sonoda T, Milsom JW. Dynamic article: long-term outcomes of patients undergoing combined endolaparoscopic surgery for benign colon polyps. Dis Colon Rectum. 2013;56(7):869–73.

    PubMed  Google Scholar 

  21. Din S, Ball AJ, Taylor E, Rutter M, Riley SA, Johal S. Polypectomy practices of sub-centimeter polyps in the English Bowel Cancer Screening Programme. Surg Endosc. 2015; 29(11): 3224-3230.

    Google Scholar 

  22. Singh N, Harrison M, Rex DK. A survey of colonoscopic polypectomy practices among clinical gastroenterologists. Gastrointest Endosc. 2004;60(3):414–8.

    PubMed  Google Scholar 

  23. Kedia P, Waye JD. Colon polypectomy: a review of routine and advanced techniques. J Clin Gastroenterol. 2013;47(8):657–65.

    PubMed  Google Scholar 

  24. Rex DK. Preventing colorectal cancer and cancer mortality with colonoscopy: What we know and what we don’t know. Endoscopy. 2010;42(4):320–3.

    CAS  PubMed  Google Scholar 

  25. Woods A, Sanowski RA, Wadas DD, Manne RK, Friess SW. Eradication of diminutive polyps: a prospective evaluation of bipolar coagulation versus conventional biopsy removal. Gastrointest Endosc. 1989;35(6):536–40.

    CAS  PubMed  Google Scholar 

  26. Efthymiou M, Taylor AC, Desmond PV, Allen PB, Chen RY. Biopsy forceps is inadequate for the resection of diminutive polyps. Endoscopy. 2011;43(4):312–6.

    CAS  PubMed  Google Scholar 

  27. Liu S, Ho SB, Krinsky ML. Quality of polyp resection during colonoscopy: are we achieving polyp clearance? Dig Dis Sci. 2012;57(7):1786–91.

    PubMed  Google Scholar 

  28. Draganov PV, Chang MN, Alkhasawneh A, et al. Randomized, controlled trial of standard, large-capacity versus jumbo biopsy forceps for polypectomy of small, sessile, colorectal polyps. Gastrointest Endosc. 2012;75(1):118–26.

    PubMed  Google Scholar 

  29. Williams CB. Small polyps: the virtues and the dangers of hot biopsy. Gastrointest Endosc. 1991;37(3):394–5.

    CAS  PubMed  Google Scholar 

  30. Monkemuller KE, Fry LC, Jones BH, Wells C, Mikolaenko I, Eloubeidi M. Histological quality of polyps resected using the cold versus hot biopsy technique. Endoscopy. 2004;36(5):432–6.

    CAS  PubMed  Google Scholar 

  31. 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(4):383–5.

    CAS  PubMed  Google Scholar 

  32. Savides TJ, See JA, Jensen DM, Jutabha R, Machicado GA, Hirabayashi K. Randomized controlled study of injury in the canine right colon from simultaneous biopsy and coagulation with different hot biopsy forceps. Gastrointest Endosc. 1995;42(6):573–8.

    CAS  PubMed  Google Scholar 

  33. Peluso F, Goldner F. Follow-up of hot biopsy forceps treatment of diminutive colonic polyps. Gastrointest Endosc. 1991;37(6):604–6.

    CAS  PubMed  Google Scholar 

  34. Gilbert DA, DiMarino AJ, Jensen DM, et al. Status evaluation: hot biopsy forceps. American society for gastrointestinal endoscopy. technology assessment committee. Gastrointest Endosc. 1992;38(6):753–6.

    CAS  PubMed  Google Scholar 

  35. Riley S. Colonoscopic polypectomy and endoscopic mucosal resection: A practical guide. http://www.bsg.org.uk/clinical-guidance/endoscopy/colonoscopic-polypectomy-and-endoscopic-mucosal-resection-a-practical-guide.html. Updated 2008. Accessed 5 June 2015.

    Google Scholar 

  36. Kim JS, Lee BI, Choi H, et al. Cold snare polypectomy versus cold forceps polypectomy for diminutive and small colorectal polyps: A randomized controlled trial. Gastrointest Endosc. 2015;81(3):741–7.

    Google Scholar 

  37. Hewett DG. Colonoscopic polypectomy: current techniques and controversies. Gastroenterol Clin North Am. 2013;42(3):443–58.

    PubMed  Google Scholar 

  38. Paspatis GA, Tribonias G, Konstantinidis K, et al. A prospective randomized comparison of cold vs hot snare polypectomy in the occurrence of postpolypectomy bleeding in small colonic polyps. Colorectal Dis. 2011;13(10):e345–8.

    CAS  PubMed  Google Scholar 

  39. Lee CK, Shim JJ, Jang JY. Cold snare polypectomy vs. cold forceps polypectomy using double-biopsy technique for removal of diminutive colorectal polyps: a prospective randomized study. Am J Gastroenterol. 2013;108(10):1593–600.

    PubMed  Google Scholar 

  40. Ichise Y, Horiuchi A, Nakayama Y, Tanaka N. Prospective randomized comparison of cold snare polypectomy and conventional polypectomy for small colorectal polyps. Digestion. 2011;84(1):78–81.

    PubMed  Google Scholar 

  41. Van Gossum A, Cozzoli A, Adler M, Taton G, Cremer M. Colonoscopic snare polypectomy: Analysis of 1485 resections comparing two types of current. Gastrointest Endosc. 1992;38(4):472–5.

    PubMed  Google Scholar 

  42. Repici A, Pellicano R, Strangio G, Danese S, Fagoonee S, Malesci A. Endoscopic mucosal resection for early colorectal neoplasia: pathologic basis, procedures, and outcomes. Dis Colon Rectum. 2009;52(8):1502–15.

    PubMed  Google Scholar 

  43. Conio M, Blanchi S, Repici A, Ruggeri C, Fisher DA, Filiberti R. Cap-assisted endoscopic mucosal resection for colorectal polyps. Dis Colon Rectum. 2010;53(6):919–27.

    PubMed  Google Scholar 

  44. Moss A, Bourke MJ, Williams SJ, et al. Endoscopic mucosal resection outcomes and prediction of submucosal cancer from advanced colonic mucosal neoplasia. Gastroenterology. 2011;140(7):1909–18.

    PubMed  Google Scholar 

  45. Moss A, Williams SJ, Hourigan LF, et al. Long-term adenoma recurrence following wide-field endoscopic mucosal resection (WF-EMR) for advanced colonic mucosal neoplasia is infrequent: results and risk factors in 1000 cases from the australian colonic EMR (ACE) study. Gut. 2015;64(1):57–65.

    Google Scholar 

  46. Luigiano C, Consolo P, Scaffidi MG, et al. Endoscopic mucosal resection for large and giant sessile and flat colorectal polyps: a single-center experience with long-term follow-up. Endoscopy. 2009;41(10):829–35.

    CAS  PubMed  Google Scholar 

  47. Buchner AM, Guarner-Argente C, Ginsberg GG. Outcomes of EMR of defiant colorectal lesions directed to an endoscopy referral center. Gastrointest Endosc. 2012;76(2):255–63.

    PubMed  Google Scholar 

  48. Steele SR, Johnson EK, Champagne B, et al. Endoscopy and polyps-diagnostic and therapeutic advances in management. World J Gastroenterol. 2013;19(27):4277–88.

    PubMed  PubMed Central  Google Scholar 

  49. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver.3). Gastric Cancer. 2011;14:113–23.

    Google Scholar 

  50. Gotoda T, Ho KY, Soetikno R, Kaltenbach T, Draganov P. Gastric ESD: current status and future directions of devices and training. Gastrointest Endosc Clin N Am. 2014;24(2):213–33.

    PubMed  Google Scholar 

  51. Draganov PV, Gotoda T, Chavalitdhamrong D, Wallace MB. Techniques of endoscopic submucosal dissection: application for the western endoscopist? Gastrointest Endosc. 2013;78(5):677–88.

    PubMed  Google Scholar 

  52. Ono S, Fujishiro M, Koike K. Endoscopic submucosal dissection for superficial esophageal neoplasms. World J Gastrointest Endosc. 2012;4(5):162–6.

    PubMed  PubMed Central  Google Scholar 

  53. Oda I, Suzuki H, Nonaka S, Yoshinaga S. Complications of gastric endoscopic submucosal dissection. Dig Endosc. 2013;25 Suppl 1:71–8.

    PubMed  Google Scholar 

  54. Tanaka S, Kashida H, Saito Y, et al. JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc. 2015;27(4):417–34.

    Google Scholar 

  55. Deprez PH, Bergman JJ, Meisner S, et al. Current practice with endoscopic submucosal dissection in Europe: position statement from a panel of experts. Endoscopy. 2010;42(10):853–8.

    CAS  PubMed  Google Scholar 

  56. Bhatt A, Abe S, Kumaravel A, Vargo J, Saito Y. Indications and techniques for endoscopic submucosal dissection. Am J Gastroenterol. 2015.

    Google Scholar 

  57. Huai ZY, Feng Xian W, Chang Jiang L, Xi Chen W. Submucosal injection solution for endoscopic resection in gastrointestinal tract: a traditional and network meta-analysis. Gastroenterol Res Pract. 2015;2015:702768.

    Google Scholar 

  58. Probst A, Golger D, Anthuber M, Markl B, Messmann H. Endoscopic submucosal dissection in large sessile lesions of the rectosigmoid: learning curve in a european center. Endoscopy. 2012;44(7):660–7.

    CAS  PubMed  Google Scholar 

  59. Hotta K, Oyama T, Shinohara T, et al. Learning curve for endoscopic submucosal dissection of large colorectal tumors. Dig Endosc. 2010;22(4):302–6.

    PubMed  Google Scholar 

  60. Saito Y, Uraoka T, Yamaguchi Y, et al. A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video). Gastrointest Endosc. 2010;72(6):1217–25.

    PubMed  Google Scholar 

  61. Kobayashi N, Yoshitake N, Hirahara Y, et al. Matched case–control study comparing endoscopic submucosal dissection and endoscopic mucosal resection for colorectal tumors. J Gastroenterol Hepatol. 2012;27(4):728–33.

    PubMed  Google Scholar 

  62. Steele SR, Brown TA, Rush RM, Martin MJ. Laparoscopic vs open colectomy for colon cancer: results from a large nationwide population-based analysis. J Gastrointest Surg. 2008;12(3):583–91.

    PubMed  Google Scholar 

  63. Beck DE, Karulf RE. Laparoscopic-assisted full-thickness endoscopic polypectomy. Dis Colon Rectum. 1993;36(7):693–5.

    CAS  PubMed  Google Scholar 

  64. Franklin Jr ME, Diaz-E JA, Abrego D, Parra-Davila E, Glass JL. Laparoscopic-assisted colonoscopic polypectomy: the Texas Endosurgery Institute experience. Dis Colon Rectum. 2000;43(9):1246–9.

    PubMed  Google Scholar 

  65. Wilhelm D, von Delius S, Weber L, et al. Combined laparoscopic-endoscopic resections of colorectal polyps: 10-year experience and follow-up. Surg Endosc. 2009;23(4):688–93.

    PubMed  Google Scholar 

  66. Ommer A, Limmer J, Mollenberg H, Peitgen K, Albrecht KH, Walz MK. Laparoscopic-assisted colonoscopic polypectomy—indications and results. Zentralbl Chir. 2003;128(3):195–8.

    CAS  PubMed  Google Scholar 

  67. Franklin Jr ME, Leyva-Alvizo A, Abrego-Medina D, et al. Laparoscopically monitored colonoscopic polypectomy: an established form of endoluminal therapy for colorectal polyps. Surg Endosc. 2007;21(9):1650–3.

    PubMed  Google Scholar 

  68. Winter H, Lang RA, Spelsberg FW, Jauch KW, Huttl TP. Laparoscopic colonoscopic rendezvous procedures for the treatment of polyps and early stage carcinomas of the colon. Int J Colorectal Dis. 2007;22(11):1377–81.

    CAS  PubMed  Google Scholar 

  69. Lee SW, Garrett KA, Shin JH, Trencheva K, Sonoda T, Milsom JW. Dynamic article: long-term outcomes of patients undergoing combined endolaparoscopic surgery for benign colon polyps. Dis Colon Rectum. 2013;56(7):869–73.

    PubMed  Google Scholar 

  70. Yan J, Trencheva K, Lee SW, Sonoda T, Shukla P, Milsom JW. Treatment for right colon polyps not removable using standard colonoscopy: combined laparoscopic-colonoscopic approach. Dis Colon Rectum. 2011;54(6):753–8.

    PubMed  Google Scholar 

  71. Franklin Jr ME, Portillo G. Laparoscopic monitored colonoscopic polypectomy: long-term follow-up. World J Surg. 2009;33(6):1306–9.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General Surgery, Section of Colon and Rectal Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, 525 East 68th Street, Box 172, New York, NY, 10065, USA

    Kelly A. Garrett MD, FACS, FASCRS & Sang W. Lee MD, FACS, FASCRS

  2. Department of Surgery, Keck School of Medicine, University of Southern California, 1441 Eastlake Ave Ste 7418, Los Angeles, CA, 90033, USA

    Sang W. Lee MD, FACS, FASCRS

Authors
  1. Kelly A. Garrett MD, FACS, FASCRS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sang W. Lee MD, FACS, FASCRS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sang W. Lee MD, FACS, FASCRS .

Editor information

Editors and Affiliations

  1. Division of Colorectal Surgery, University Hospitals Case Medical Center Case Western Reserve University, Cleveland, OH, USA

    Scott R. Steele

  2. Cleveland Clinic, Cleveland, OH, USA

    Tracy L. Hull

  3. Tufts University School of Medicine, Lahey Hospital & Medical Center, Burlington, MA, USA

    Thomas E. Read

  4. Ambrose and Gladys Bowyer, Loyola University, Chicago, IL, USA

    Theodore J. Saclarides

  5. University of Texas Medical Branch at Galveston, Galveston, TX, USA

    Anthony J. Senagore

  6. Ochsner Medical Center, New Orleans, LA, USA

    Charles B. Whitlow

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

Combined endoscopic-laparoscopic surgery for removal of a polyp. Courtesy of Sang Lee, MD (MP4 331763 kb) (M4V 331763 kb)

Rights and permissions

Reprints and permissions

Copyright information

© 2016 ASCRS (American Society of Colon and Rectal Surgeons)

About this chapter

Cite this chapter

Garrett, K.A., Lee, S.W. (2016). Endoscopic Management of Polyps, Polypectomy, and Combined Endoscopic and Laparoscopic Surgery. In: Steele, S.R., Hull, T.L., Read, T.E., Saclarides, T.J., Senagore, A.J., Whitlow, C.B. (eds) The ASCRS Textbook of Colon and Rectal Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-25970-3_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-25970-3_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-25968-0

  • Online ISBN: 978-3-319-25970-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation