Polyp Resection and Removal Procedures: Insights From the 2017 Digestive Disease Week

Colorectal cancer (CRC) is an important public health issue not only because of its high incidence but also for its high mortality rate. When CRC is diagnosed at an early stage, the 5-year relative survival rate reaches 89.9%. However, only 39% of patients with CRC are diagnosed at this stage. Screening decreases both the incidence of CRC and the number of CRC-related deaths. There are several options available for screening, and colonoscopy is one of the most common methods utilized in the United States. Screening colonoscopy is associated with durable protection from CRC. However, it has become increasingly apparent in recent years that polyp detection and resection have not been completely effective in clinical practice. Because the protective benefit of colonoscopy is variable, quality benchmarks have been established to improve its clinical effectiveness. The adenoma detection rate (ADR) directly correlates with the incidence and mortality of postcolonoscopy (or interval) CRCs. It is now routine to remove large polyps (≥20 mm) using advanced techniques for endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). Recent studies have helped identify which colorectal lesions are at higher risk of invasive cancer and would benefit from a complete en bloc resection. Such data may guide endoscopists in making a decision on whether to use ESD or EMR for removal of large lesions. An increased number of studies have reported on the efficacy and safety of cold snare resection, even for larger polyps. These data suggest that cold snare resection may be as effective, and perhaps safer, than hot snare resection for polyps up to 1 to 2 cm in size. However, data on the threshold for cold snare resection and the value of submucosal injectates are still lacking. Use of submucosal injection is generally preferred for larger polyps, particularly those located in the proximal colon, where the colonic wall is thinner.