Resect and Retrieve Colorectal Polyps: Time for New Insights

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Oncology

Background:

• Polyp retrieval post-colorectal polypectomy is vital for histopathology and surveillance.
• Current retrieval rates exceed 90%, but clinical practice varies, especially for polyps <10 mm.
• Lack of standardized methods contributes to heterogeneity in polyp retrieval.

Purpose of the Study:

• To review current evidence on colorectal polyp retrieval techniques.
• To examine the impact of lesion size and device-specific considerations.
• To evaluate alternative strategies and emerging technologies for polyp management.

Main Methods:

• Systematic review of polyp retrieval techniques (suction, nets, water-based methods).
• Analysis of "resect and discard" and "diagnose and leave in situ" strategies.
• Assessment of advanced imaging (HD endoscopy, virtual chromoendoscopy) and AI-driven CADx.

Main Results:

• Significant heterogeneity exists in clinical practice for polyp retrieval, particularly for smaller lesions.
• Barriers to implementing alternative strategies include medico-legal risks and diagnostic variability.
• Advanced imaging and AI show promise for improving diagnostic accuracy of diminutive polyps.

Conclusions:

• Updated, evidence-based frameworks are needed for polyp retrieval and surveillance.
• Technological advancements must be integrated to ensure diagnostic precision and patient safety.
• Standardization of polyp retrieval methods is essential for effective colorectal cancer prevention.