Complete Histologic Resection of Adenomatous Polyps?

Colorectal cancer is the second most common cause of cancer death in the US. Colonoscopy is considered the best test colorectal cancer screening. It allows resection of adenomatous polyps (a known cancer precursor) and thus, interrupt the adenoma-carcinoma sequence. Despite the potential benefit of screening colonoscopy recent studies have reported cases of colorectal cancers in a short interval after prior screening or surveillance colonoscopies. One possible cause of such interval cancers may be incomplete resection of adenomatous polyps and hence ongoing growth and cancer development in such lesions. Complete resection may be particularly important for polyps of at least 5mm in size as up 10% of such polyps higher risk lesions as villous adenoma, tubulovillous adenoma, high grade dysplasia, or early carcinoma. Although adenoma resection of sessile and flat adenomatous polyps between 5 and 20mm is believed to be well standardized data on complete resection of adenomatous tissue are sparse. This may be related to the assumption that using a snare with electro-cautery will successfully remove the polyp and cauterize remaining marginal adenomatous tissue and hence completely remove and or destroy the lesion. The investigators are interested in examining how often sessile adenomatous polyps between 5 and 20mm are completely removed using standard polypectomy snare. The investigation was also directed at a comparison between complete resection of polyps between 5 and 9mm and 10 and 20mm.

Sex

All

Minimum age

40 Years

Maximum age

85 Years

Inclusion Criteria:

* Any patient ≥40 and \<85 who presents for a colonoscopy and does not meet any of the exclusion criteria mentioned below will be asked to participate
* All patients who are found to have colonic polyp between 5 and 20mm in size will be included in the study

Exclusion Criteria:

* Pedunculated polyps (estimated stalk diameter \< 50% polyp head diameter, stalk at least 5 mm)
* Any suspicion of perforation or deeper defects after polypectomy, irrespective whether treated or not.
* Post-polypectomy bleeding requiring hemostasis.
* Patients with known inflammatory bowel disease or active colitis
* Patients who are receiving an emergency colonoscopy
* Poor general health (ASA class\>3)
* Patients on coumadin or with coagulopathy with an elevated INR ≥1.8, or platelets \<50.
* Poor bowel preparation
* Patients who do not consent
* Pregnancy

• DERIVEDPohl H, Srivastava A, Bensen SP, Anderson P, Rothstein RI, Gordon SR, Levy LC, Toor A, Mackenzie TA, Rosch T, Robertson DJ. Incomplete polyp resection during colonoscopy-results of the complete adenoma resection (CARE) study. Gastroenterology. 2013 Jan;144(1):74-80.e1. doi: 10.1053/j.gastro.2012.09.043. Epub 2012 Sep 25. PMID 23022496