Skip to main content
SpringerLink
Log in
Book cover

Advanced Surgical Techniques for Rural Surgeons pp 25–33Cite as

Endomucosal Resection of Colon Polyps and Control of Postpolypectomy Bleeding

  • Chapter
  • First Online:

  • 1265 Accesses

Abstract

Careful assessment of the ability to remove a difficult polyp should be made prior to any attempt at polypectomy. Availability of the proper equipment and trained ancillary personnel should be confirmed prior to attempting an advanced polypectomy. Delaying the polypectomy until all resources are optimal will increase success and decrease complications. Endomucosal resection (EMR) is generally defined as the removal of a flat or sessile polyp confined to the mucosa or submucosa, usually for lesions >2 cm in size. Injection-assisted, cap-assisted and ligation-assisted techniques have been described to perform EMR. EMR is the most widely accepted method of performing advanced polypectomy. Endoscopic submucosal dissection involves dissecting the polyp off the submucosal space and is a more meticulous, time-consuming, and technically challenging method of performing advanced polypectomy.

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

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Ahmed NA, Kochman ML, Long WB, Furth EE, Ginsberg GG. Efficacy, safety, and clinical outcomes of endoscopic mucosal resection: a study of 101 cases. Gastrointest Endosc. 2002;55(3):390–6.

    Article  Google Scholar 

  2. Baillie J. Postpolypectomy bleeding. Am J Gastroenterol. 2007;102:1151–3.

    Article  PubMed  Google Scholar 

  3. Benson BC, Myers JJ, Laczek JT. Postpolypectomy electrocoagulation syndrome: a mimicker of colonic perforation. Case Rep Emerg Med. 2013;2013:687931. http://dx.doi.org/10.1155/2013/687931.

    PubMed Central  PubMed  Google Scholar 

  4. Brooker JC, Saunders BP, Shah SG, Thapar CJ, Suzuki N, Williams CB. Treatment with argon plasma coagulation reduces recurrence after piecemeal resection of large sessile colonic polyps: a randomized trial and recommendations. Gastrointest Endosc. 2002;55(3):371–5.

    Article  PubMed  Google Scholar 

  5. Carpenter S, Petersen BT, Chuttani R, Croffie J, DiSario J, Liu J, Mishkin D, Shah R, Somogyi L, Tierney W, Song LM. Polypectomy devices. Gastrointest Endosc. 2007;65:741–9.

    Article  PubMed  Google Scholar 

  6. Church J. Complications of Colonoscopy. Gastrointest Endosc Clin N Am. 2013;42(3):639–57.

    Article  Google Scholar 

  7. Di Giorgio P, De Luca L, Calcagno G, Rivellini G, Mandato M, De Luca B. Detachable snare versus epinephrine injection in the prevention of postpolypectomy bleeding: a randomized and controlled study. Endoscopy. 2004;36(10):860–3. PMID: 15452780.

    Article  PubMed  Google Scholar 

  8. Fatima H, Rex DK. Minimizing endoscopic complications: colonoscopic polypectomy. Gastrointest Endosc Clin N Am. 2007;17:145–56.

    Article  PubMed  Google Scholar 

  9. Feagins LA, Iqbal R, Harford WV, Halai A, Cryer BL, Dunbar KB, Davila RE, Spechler SJ. Low rate of postpolypectomy bleeding among patients who continue thienopyridine therapy during colonoscopy. Clin Gastroenterol Hepatol. 2013;11(10):1325–32. doi:10.1016/j.cgh.2013.02.003. Epub 2013 Feb 9. PMID: 23403011.

    Article  PubMed  Google Scholar 

  10. Frimberger E, von Delius S, Rosch T, Schmid RM. Colonoscopy and polypectomy with a side-viewing endoscope. Endoscopy. 2007;39(5):462–5.

    Article  CAS  PubMed  Google Scholar 

  11. Fyock CJ, Draganov PV. Colonoscopic polypectomy and associated techniques. World J Gastroenterol. 2010;16(29):3630–7.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Gimeno-García AZ, de Ganzo ZA, Sosa AJ, Pérez DN, Quintero E. Incidence and predictors of postpolypectomy bleeding in colorectal polyps larger than 10 mm. Eur J Gastroenterol Hepatol. 2012;24(5):520–6. doi:10.1097/MEG.0b013e328350fcdc. PMID: 22465971.

    Article  PubMed  Google Scholar 

  13. Ginsberg GG, Barkun AN, Bosco JJ, Burdick JS, Isenbert GA, Nakao NL, Petersen BT, Silverman WB, Slivka A, Kelsey PB. Endoscopic tattooing. Gastrointest Endosc. 2002;55(7):811–4.

    Article  PubMed  Google Scholar 

  14. Iishi H, Tatsuta M, Iseki K, Narahara H, Uedo N, Sakai N, Ishikawa H, Otani T, Ishiguro S. Endoscopic piecemeal resection with submucosal saline injection of large sessile colorectal polyps. Gastrointest Endosc. 2000;51:697–700.

    Article  CAS  PubMed  Google Scholar 

  15. Jeon JW, Shin HP, Lee JI, Joo KR, Pack KM, Cha JM, Park JJ, Lim JU, Lim K. The risk of postpolypectomy bleeding during colonoscopy in patients with early liver cirrhosis. Surg Endosc. 2012;26(11):3258–63. doi:10.1007/s00464-012-2334-0. Epub 2012 May 31. PMID: 22648106.

    Article  PubMed  Google Scholar 

  16. Kantsevoy SV, Adler DG, Conway JD, Diehl DL, Farraye FA, Kwon R, Mamula P, Rodriquez S, Shah RJ, Wong Kee Song LM, Tierney WM. Endoscopic mucosal resection and endoscopic submucosal dissection. Gastrointest Endosc. 2008;68(1):11–8. doi:10.1016/j.gie.2008.01.037.

    Article  PubMed  Google Scholar 

  17. Kapetanos D, Beltsis A, Chatzimavroudis G, Katsinelos P. Postpolypectomy bleeding: incidence, risk factors, prevention, and management. Surg Laparosc Endosc Percutan Tech. 2012;22(2):102–7. doi:10.1097/SLE.0b013e318247c02e. PMID: 22487620.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  19. Khashab M, Eid E, Rusche M, Rex DK. Incidence and predictors of “late” recurrences after endoscopic piecemeal resection of large sessile adenomas. Gastrointest Endosc. 2009;70:344–9.

    Article  PubMed  Google Scholar 

  20. Kim HS, Kim TI, Kim WH, Kim YH, Kim HJ, Yang SK, Myung SJ, Byeon JS, Lee MS, Chung IK, Jung SA, Jeen YT, Choi JH, Choi KY, Choi H, Han DS, Song JS. Risk factors for immediate postpolypectomy bleeding of the colon: a multicenter study. Am J Gastroenterol. 2006;101(6):1333–41. PMID: 16771958.

    Article  PubMed  Google Scholar 

  21. Komeda Y, Suzuki N, Marshall S, Thomas-Gibson S, Vance M, Fraser C, Patel K, Saunders BP. Factors associated with failed polyp retrieval at screening colonoscopy. Gastrointest Endosc. 2013;77:395–400.

    Article  PubMed  Google Scholar 

  22. Kouklakis G, Mpoumponaris A, Gatopoulou A, Efraimidou E, Manolas K, Lirantzopoulos N. Endoscopic resection of large pedunculated colonic polyps and risk of postpolypectomy bleeding with adrenaline injection versus endoloop and hemoclip: a prospective, randomized study. Surg Endosc. 2009;23(12):2732–7. doi:10.1007/s00464-009-0478-3. Epub 2009 May 9. PMID: 19430833.

    Article  PubMed  Google Scholar 

  23. Lee SH, Cho WY, Kim HJ, Kim HJ, Kim YH, Chung IK, Kim HS, Park SH, Kim SJ. A new method of EMR: submucosal injection of a fibrinogen mixture. Gastrointest Endosc. 2004;59(2):220–4.

    Article  PubMed  Google Scholar 

  24. Lee SH, Chung IK, Kim SJ, Kim JO, Ko BM, Kim WH, Kim HS, Park DI, Kim HJ, Byeon JS, Yang SK, Jang BI, Jung SA, Jeen YT, Choi JH, Choi H, Han DS, Song JS. Comparison of postpolypectomy bleeding between epinephrine and saline submucosal injection for large colon polyps by conventional polypectomy: a prospective randomized, multicenter study. World J Gastroenterol. 2007;13(21):2973–7. PMID: 17589949.

    PubMed Central  PubMed  Google Scholar 

  25. Lee TJW, Rutter MD, Blanks RG. Colonoscopy quality measures: experience from the NHS Bowel Cancer Screening Programme. Gut. 2012;61:1050–7.

    Article  PubMed  Google Scholar 

  26. Levin B, Lieberman DA, McFarland B, Smith RA, Brooks D, Andrews KS, Dash C, Giardiello FM, Glick S, Levin TR, Pickhardt P, Rex DK, Thorson A, Winauer SJ. 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;58:130–60.

    Article  PubMed  Google Scholar 

  27. Lukens FJ, Gómez V, Patel MK, Achem SR, Picco MF. Colonoscopic postpolypectomy bleeding in patients that resumed warfarin: not as frequent as we may think. J Clin Gastroenterol. 2013;47(3):290–2. doi:10.1097/MCG.0b013e31826baaec. No abstract available. PMID: 23059412.

    Article  PubMed  Google Scholar 

  28. Misra SP, Dwivedi M. Colonoscopy and colonoscopic polypectomy using side-viewing endoscope: a useful, effective and safe procedure. Dig Dis Sci. 2008;53:1285–8.

    Article  PubMed  Google Scholar 

  29. Nishihara R, Wu K, Lochhead P, Morikawa T, Liao X, Qian ZR, Inamura K, Kim SA, Kuchiba A, Yamauchi M, Imamura Y, Willett WC, Rosner BA, Fuchs CS, Giovannucci E, Ogino S, Chan AT. Long-term colorectal-cancer incidence and mortality after lower endoscopy. N Engl J Med. 2013;369(12):1095–105.

    Article  CAS  PubMed  Google Scholar 

  30. Park SY, Kim HS, Yoon KW, Cho SB, Lee WS, Park CH, Joo YE, Choi SK, Rew JS. Usefulness of cap-assisted colonoscopy during colonoscopic EMR:a randomized, controlled trial. Gastrointest Endosc. 2011;74:869–75.

    Article  PubMed  Google Scholar 

  31. Parra-Blanco A, Kaminaga N, Kojima T, Endo Y, Uragami N, Okawa N, Hattori T, Takahashi H, Fujita R. Hemoclipping for postpolypectomy and postbiopsy colonic bleeding. Gastrointest Endosc. 2000;51(1):37–41. PMID: 10625793.

    Article  CAS  PubMed  Google Scholar 

  32. Paspatis GA, Paraskeva K, Theodoropoulou A, Mathou N, Vardas E, Oustamanolakis P, Chlouverakis G, Karagiannis I. A prospective, randomized comparison of adrenaline injection in combination with detachable snare versus adrenaline injection alone in the prevention of postpolypectomy bleeding in large colonic polyps. Am J Gastroenterol. 2006;101(12):2805; quiz 2913. Epub 2006 Oct 6. PMID: 17026560.

    Article  CAS  PubMed  Google Scholar 

  33. Paspatis GA, Tribonias G, Konstantinidis K, Theodoropoulou A, Vardas E, Voudoukis E, Manolaraki MM, Chainaki I, Chlouverakis G. 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. doi:10.1111/j.1463-1318.2011.02696.x. PMID: 21689363.

    Article  CAS  PubMed  Google Scholar 

  34. Qaseem A, Denberg TD, Hopkins Jr RH, Humphrey LL, Levine J, Sweet DE, Shekelle P, Clinical Guidelines Committee of the American College of Physicians. Screening for colorectal cancer; a guidance statement from the American College of Physicians. Ann Intern Med. 2012;156(5):378–86.

    Article  PubMed  Google Scholar 

  35. Rabeneck L, Paszat LF, Hilsden RJ, et al. Bleeding and perforation after outpatient colonoscopy and their risk factors in usual clinical practice. Gastroenterology. 2008;135(6):1899–906. PMID 18938166.

    Article  PubMed  Google Scholar 

  36. Rex DK, Johnson DA, Anderson JC, Schoenfeld PS, Burke CA, Inadomi JM, American College of Gastroenterology. American College of Gastroenterology guidelines for colorectal cancer screening. Am J Gastroenterol. 2009;104(3):739–50.

    Article  PubMed  Google Scholar 

  37. Sawhney MS, Salfiti N, Nelson DB, Lederle FA, Bond JH. Risk factors for severe delayed postpolypectomy bleeding. Endoscopy. 2008;40(2):115–9. doi:10.1055/s-2007-966959. PMID: 18253906.

    Article  CAS  PubMed  Google Scholar 

  38. SEER Stat Fact Sheet; colon and rectum. National Cancer Institute. Available at: http://seer.cancer.gov/statfacts/html/colorect.html. Accessed 23 Oct 2013.

  39. Shatz BA, Thavorides V. Colonic tattoo for follow-up of endoscopic sessile polypectomy. Gastrointest Endosc. 1991;37:59–60.

    Article  CAS  PubMed  Google Scholar 

  40. Singaram C, Torbey CF, Jacoby RF. Delayed postpolypectomy bleeding. Am J Gastroenterol. 1995;90(1):146–7. PMID: 7801918.

    CAS  PubMed  Google Scholar 

  41. Singh M, Mehta N, Murthy UK, Kaul V, Arif A, Newman N. Postpolypectomy bleeding in patients undergoing colonoscopy on uninterrupted clopidogrel therapy. Gastrointest Endosc. 2010;71(6):998–1005. doi:10.1016/j.gie.2009.11.022. Epub 2010 Mar 11PMID: 20226452.

    Article  PubMed  Google Scholar 

  42. Sonnenberg A. Management of delayed postpolypectomy bleeding: a decision analysis. Am J Gastroenterol. 2012;107(3):339–42. doi:10.1038/ajg.2011.426. PMID: 22388016.

    Article  PubMed  Google Scholar 

  43. Strate LL. Lower GI bleeding: epidemiology and diagnosis. Gastroenterol Clin North Am. 2005;34:643–64.

    Article  PubMed  Google Scholar 

  44. 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;38:472–5.

    Article  PubMed  Google Scholar 

  45. Waye J. It ain’t over ‘til it’s over: retrieval of polyps after colonoscopic polypectomy. Gastrointest Endosc. 2005;62:257–9.

    Article  PubMed  Google Scholar 

  46. Whitlow CB. Endoscopic treatment for lower gastrointestinal bleeding. Clin Colon Rectal Surg. 2010;23:31–6.

    Article  PubMed Central  PubMed  Google Scholar 

  47. Wu XR, Church JM, Jarrar A, Liang J, Kalady MF. Risk factors for delayed postpolypectomy bleeding: how to minimize your patients’ risk. Int J Colorectal Dis. 2013;28(8):1127–34. doi:10.1007/s00384-013-1661-5. Epub 2013 Feb 26. PMID: 23440363.

    Article  PubMed  Google Scholar 

  48. Yamamoto H, Kawata H, Sunada K, Satoh K, Kaneko Y, Ido K, Sugano K. Success rate of curative endoscopic mucosal resection with circumferential mucosal incision assisted by submucosal injection of sodium hyaluronate. Gastrointest Endosc. 2002;56(4):507–12.

    Article  PubMed  Google Scholar 

  49. Zafar A, Mustafa M, Chapman M. Colorectal polyps: when should we tattoo? Surg Endosc. 2012;26(11):3264–6.

    Article  PubMed  Google Scholar 

  50. Zlatanic J, Waye JD, Kim PS, Baiocco PJ, Gleim GW. Large sessile colonic adenomas: use of argon plasma coagulator to supplement piecemeal snare polypectomy. Gastrointest Endosc. 1999;49(6):731–5.

    Article  CAS  PubMed  Google Scholar 

Suggested Reading

  • Carpenter S, Petersen BT, Chuttani R, Croffie J, DiSario J, Liu J, Mishkin D, Shah R, Somogyi L, Tierney W, Song LM. Polypectomy devices. Gastrointest Endosc. 2007;65:741–9.

    Article  PubMed  Google Scholar 

  • Church J. Complications of colonoscopy. Gastrointest Endosc Clin N Am. 2013;42(3):639–57.

    Article  Google Scholar 

  • Fatima H, Rex DK. Minimizing endoscopic complications: colonoscopic polypectomy. Gastrointest Endosc Clin N Am. 2007;17:145–56.

    Article  PubMed  Google Scholar 

  • Fyock CJ, Draganov PV. Colonoscopic polypectomy and associated techniques. World J Gastroenterol. 2010;16(29):3630–7.

    Article  PubMed Central  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  • Waye J. It ain’t over ‘til it’s over: retrieval of polyps after colonoscopic polypectomy. Gastrointest Endosc. 2005;62:257–9.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, General Surgery Service, Tripler Army Medical Center, Honolulu, HI, 96859, USA

    Ronald A. Gagliano Jr. M.D., F.A.S.C.R.S.

  2. Division of Gastroenterology, Department of Medicine, Tripler Army Medical Center, Honolulu, HI, 96859, USA

    Patrick R. Kenny D.O.

Authors
  1. Ronald A. Gagliano Jr. M.D., F.A.S.C.R.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Patrick R. Kenny D.O.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ronald A. Gagliano Jr. M.D., F.A.S.C.R.S. .

Editor information

Editors and Affiliations

  1. Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA

    Amy L. Halverson

  2. Department of Surgery, Mithoefer Center for Rural Surgery, Cooperstown, New York, USA

    David C. Borgstrom

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer Science+Business Media New York

About this chapter

Cite this chapter

Gagliano, R.A., Kenny, P.R. (2015). Endomucosal Resection of Colon Polyps and Control of Postpolypectomy Bleeding. In: Halverson, A., Borgstrom, D. (eds) Advanced Surgical Techniques for Rural Surgeons. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1495-1_3

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-1495-1_3

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1494-4

  • Online ISBN: 978-1-4939-1495-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation