Injection-incision--assisted snare resection of large sessile colorectal polyps

It can be difficult, even for experienced endoscopists, to completely remove large sessile colorectal polyps. We attempted to remove large sessile colorectal polyps without complication and residual tumors.

Our new technique is characterized by submucosal pre-injection with a large volume of saline solution and then circumferential incision outside the lesion before resection using a special needle-tipped snare. The mean size of 33 polyps (including 9 elevated sessile, 20 flat nodular [villous], and 4 flat sessile polyps), was 4.0 cm (range, 3.0-8.5 cm).

Twenty-five (76%) were resected piecemeal and the remainder as a single specimen. Mild to moderate bleeding occurred in 3 (9.1%), but there was no clinically significant bleeding or perforation. No residual or recurrent tumors were recognized. Invasive carcinoma was revealed most frequently (44%) in elevated sessile polyps; none occurred in flat nodular polyps.

Our removal technique appears to be safe and effective. Flat nodular polyps of any size are a particularly good indication for removal by this technique.