A survey of colonoscopic polypectomy practice amongst Israeli gastroenterologists

Polypectomy techniques have been implicated as factors in the effectiveness of polyp resection. The range of polypectomy practices among gastroenterologists in Israel is unknown.

A structured survey was sent to all Israeli gastroenterology departments in all 15 major academic hospitals and to 3 central outpatient clinics.

The survey was completed by 100 clinicians (45% contacted) derived from 13 of 15 academic centers (85%) and from all 3 outpatient clinics. Significant differences were noted in the preferred polypectomy for the resection of polyps 1-3 mm and 7-9 mm in diameter whereas for those polyps 4-6 mm in diameter, both the hot forceps and hot snare were most commonly used technique. Coagulation was employed in 42% of cases, pure cutting in 20% and blend current in 38% of cases. Narrow band imaging was used by 54% of practitioners, and only 33% of gastroenterologists regularly used dye spraying techniques. When removing pedunculated polyps >1 cm in diameter, 75% did not use any specific measures designed to prevent perforation or hemorrhage. Performance of >300 colonoscopies per year was associated with a greater use of dye spraying techniques and working in a hospital was more likely to be accompanied by clip deployment to larger polypectomy stalks as part of the procedure.

Our results demonstrate considerable heterogeneity in the techniques used for removal of polyps <1 cm. Most practitioners do not regularly use advanced techniques for polyp detection or for the prevention of post-polypectomy bleeding.