Abstract
The first goal of polyp treatment is the endoscopic resection of the polyp during colonoscopy. Various methods (e.g., cold biopsy, hot biopsy, snare, and hot snaring) are applied based on the size and location of the polyp. Four techniques were defined for removing small polyps. If the polyp is smaller than 3 mm and is located especially at the right colon, it can be resected by forceps polypectomy (cold biopsy). Entire lesion should be within the jaws of the biopsy forceps and, when possible, lesion should be removed all together by a single bite. If residual polyp tissue is observed, a second procedure might be required. Jumbo forceps can be useful for resecting the polyp completely at the first trial. The advantage of this technique is its low risk. Hot biopsy procedure is similar to the cold biopsy. Here, after the polyp is engulfed and pulled slightly, diathermy is applied with a catheter in order to ablate its stem. It is suitable for polyps larger than 5 mm. The disadvantages of this technique are postpolypectomy bleeding and risk of perforation. The latter is the result of excessive diathermy. Accordingly, especially when whitening is observed on the polyp stem, diathermy should be ceased. Many colonoscopists gave up the hot biopsy technique due to its inconvenience. Cold snaring is preferred for sessile polyps smaller than 7 mm. On the other hand, it is difficult to resect the lesions bigger than 7 mm using cold snare without diathermy and has an increased bleeding risk. Polyps bigger than 7–8 mm in size require diathermy with snare (hot snaring). It is indicated for cases unsuitable for polypectomy, when the polyp cannot be removed completely. There are two fundamental indicators of polyp surgery: (1) Sessile or pedunculated polyps that cannot be removed endoscopically (difficult polyps, see (Table 10.1)), (2) polyps with a risk of malignity, especially those with invasive carcinoma.
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Demiray, O., Gonullu, D. (2015). Surgical Management of Colon Polyps. In: Engin, O. (eds) Colon Polyps and the Prevention of Colorectal Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-17993-3_10
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DOI: https://doi.org/10.1007/978-3-319-17993-3_10
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