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The suction pseudopolyp technique: A novel method for the removal of small flat nonpolypoid lesions of the colon and rectum

journal contribution
posted on 2009-12-14, 00:00 authored by V Pattullo, M J Bourke, K L Tran, D McLeod, S J Williams, A A Bailey, Sina Alexander, A Mishra, J Co
Background and study aims: Small flat nonpolypoid lesions of the colorectum can be technically difficult to target and completely remove; techniques such as hot biopsy forceps electrocauterization are associated with serositis, delayed bleeding, and perforation. This study aimed to describe a novel technique for the removal of such lesions and demonstrate its safety and efficacy. Patients and methods: Patients aged 1880 years with flat nonpolypoid lesions (Paris-Japanese classification 0-IIa and 0-IIb, measuring less than 10mm) identified at colonoscopy were included in this prospective study. The lesions were removed by the suction pseudopolyp technique (SPT): the lesion is aspirated into the suction channel of the colonoscope and continuous suction applied for 5 seconds whilst the colonoscope is gently retracted. On release of the suction, the resulting pseudopolyp containing the lesion and a margin of normal tissue is easily ensnared and resected. The primary outcomes were endoscopic completeness of polyp resection and complication rate. Results: Over a 12-month period, 1231 polyps were removed during 2656 colonoscopies; 126 polyps (in 101 patients) met inclusion criteria. Complete endoscopic resection was achieved in 100% of the polyps, without immediate or delayed complication. Of the resected lesions, 57% had malignant potential (adenomas 47% and sessile serrated lesions 10%); a higher proportion of lesions removed from the right colon had malignant potential compared with those from the left colon (75% vs. 41%, P=0.0066). Conclusions: Diminutive flat lesions of the colorectum are predominantly adenomas and sessile serrated lesions. SPT is a safe, effective, and reproducible therapy for removal of these lesions.

History

Journal

Endoscopy

Volume

41

Issue

12

Pagination

1032 - 1037

ISSN

0013-726X

eISSN

1438-8812

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