Colonoscopic polypectomy: indication, technique, and therapeutic implications

The flexible fibroscopic colonoscope has changed the way we approach colonic disease. The technique of safe, effective colonoscopy is discussed including the indications and contraindications for therapeutic intervention via the colonoscope. The techniques of polypectomy is described, including some tips for methodology gained by the broad experience of the author, and admonition against the possible complications which can be life-threatening. The application for polypectomy in the presence of in-situ or invasive cancer is presented. The possible future development of colonoscopic and laparoscopic techniques are presented. The article concludes with a discussion of the monumental work of the National Polyp Study documenting that patients undergoing polypectomy have a significant reduction in the incidence of colon cancer. Application of the knowledge to the general population requires the identification of at-risk populations.