Introduction Polypectomy is a commonly performed therapeutic intervention and all colonoscopists should be able to perform the procedure safely and effectively. Complications can include perforation and bleeding. Practice has evolved considerably in recent years and there is a range of equipment and techniques available for different clinical settings. The recommended technique for removal of polyps from the right colon include cold snaring for polyps upto 7 mm and hot snare for polyps 8 mm or greater. It is recommended to avoid cold biopsy except in tiny polyps and to avoid using hot biopsy altogether. We wanted to assess the polypectomy techniques used in our hospital and compare these to recommendations provided by the British Society of Gastroenterology guidance document.
Methods The aim was to assess the method of colonic polypectomy used in comparison to recommendations by all endoscopists at our district general hospital. A prospective assessment of polypectomy technique from the right colon was performed from a district general hospital in North London over 6 months from October 2009. Endoscopy nursing staff were asked to document site and method used to remove and retrieve the polyp. Patients were identified prospectively from nursing records of the procedures from the endoscopy registry book and then the polypectomy technique used was scrutinised.
Results A total of 39 polypectomies from the right colon were documented during the 6 months study period, with 29 completed by a Gastroenterologist and 10 by a surgical colleague. The size of polypectomy varied between 2 mm and 15 mm. In the Cold biopsy group, there were 3 polyps >6 mm (6, 7 and 8 mm) in size and these three were completed by a surgeon. In the Cold Snare group, there was 1 polyp >7 mm (9 mm) in size and this was removed by a surgeon by this method. In the Hot biopsy group, there were 3 polyps (1, 4, 5 mm) in size and all were removed by a surgeon with this technique.
Conclusion Our results show that there are varying techniques and methods used to excise polyps from the right colon. Despite increasing awareness of the thinness of the right colonic wall and hence increase risk of transmural thermal injury associated with hot biopsy this continues to be performed, in our study by surgical colleagues only. Despite cold biopsy technique likely to leave behind residual tissue, it continues to be used for polyps up to 8 mm in our study. For the cold snare technique guidance recommends use for polyps up to 7 mm to reduce risk of bleeding yet, in our study one cold snare was carried out for a 9 mm polyp. More awareness is required in the appropriate polypectomy technique for right sided polyps to improve efficacy.
Competing interests None declared.
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