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

Abstract

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 18 - 80 years with flat nonpolypoid lesions (Paris-Japanese classification 0-IIa and 0-IIb, measuring less than 10 mm) 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.

• Authors: V Pattullo, M J Bourke, K L Tran, D McLeod, S J Williams, A A Bailey, S Alexander, A Mishra, J Co
• Journal: Endoscopy (Endoscopy) Vol. 41 Issue 12 Pg. 1032-7 (Dec 2009) ISSN: 1438-8812 [Electronic] Germany
• PMID: 19899034 (Publication Type: Journal Article)
• Copyright: Georg Thieme Verlag KG Stuttgart New York.

Topics

• Adenoma (pathology, surgery)
• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Colonic Neoplasms (pathology, surgery)
• Colonoscopy (methods)
• Humans
• Middle Aged
• Rectal Neoplasms (pathology, surgery)
• Suction
• Young Adult