Difficult colon polypectomy  

作　　者：Klaus Vormbrock Klaus M nkemüller 

机构地区：[1]Department of Internal Medicine, Gastroenterology and Infectious Diseases,Marienhospital Bottrop, 46242 Bottrop, Germany [2]Division of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University,15003 Magdeburg, Germany

出　　处：《World Journal of Gastrointestinal Endoscopy》2012年第7期269-280,共12页世界胃肠内镜杂志（英文版）（电子版）

摘　　要：Colorectal cancer (CRC) is one of the leading causes of death from cancer in the world. We now know that 90% of CRC develop from adenomatous polyps. Polypectomy of colon adenomas leads to a significant reduction in the incidence of CRC. At present most of the polyps are removed endoscopically. The vast majority of colorectal polyps identified at colonoscopy are small and do not pose a significant challenge for resection to an appropriately trained and skilled endoscopist. Advanced polypectomy techniques are intended for the removal of difficult colon polyps. We have defined a "difficult polyp" as any lesion that due to its size, shape or location represents a challenge for the colonoscopist to remove. Although many "difficult polyps" will be an easy target for the advanced endoscopist, polyps that are larger than 15 mm, have a large pedicle, are flat and extended, are difficult to see or are located in the cecum or any angulated portion of the colon should be always considered difficult. Although very successful,advanced resection techniques can potentially cause serious, even life-threatening complications. Moreover, post polypectomy complications are more common in the presence of difficult polyps. Therefore, any endos-copist attempting advanced polypectomy techniques should be adequately supervised by an expert or have an excellent training in interventional endoscopy. This review describes several useful tips and tricks to deal with difficult polyps.Colorectal cancer (CRC) is one of the leading causes of death from cancer in the world. We now know that 90% of CRC develop from adenomatous polyps. Polypectomy of colon adenomas leads to a significant reduction in the incidence of CRC. At present most of the polyps are removed endoscopically. The vast majority of colorectal polyps identified at colonoscopy are small and do not pose a significant challenge for resection to an appropriately trained and skilled endoscopist. Advanced polypectomy techniques are intended for the removal of difficult colon polyps. We have defined a “difficult polyp” as any lesion that due to its size, shape or location represents a challenge for the colonoscopist to remove. Although many “difficult polyps” will be an easy target for the advanced endoscopist, polyps that are larger than 15 mm, have a large pedicle, are flat and extended, are difficult to see or are located in the cecum or any angulated portion of the colon should be always considered difficult. Although very successful, advanced resection techniques can potentially cause serious, even life-threatening complications. Moreover, post polypectomy complications are more common in the presence of difficult polyps. Therefore, any endoscopist attempting advanced polypectomy techniques should be adequately supervised by an expert or have an excellent training in interventional endoscopy. This review describes several useful tips and tricks to deal with difficult polyps.

关 键 词：COLONOSCOPY POLYPECTOMY MUCOSECTOMY Colon polyp POLYP Endoscopic mucosal resection MUCOSECTOMY Endoscopic submucosal dissection 

分 类 号：R735.3[医药卫生—肿瘤]