Most
colonic polyps are small, and several polypectomy techniques are available. We aimed to describe the variation in polypectomy techniques employed for the removal of sub-centimeter
polyps in relation to
polyp characteristics, completeness of histological excision and safety.
METHODS: Prospectively collected data relating to the removal of sub-centimeter
polyps over a 3-year period (between January 2010 and December 2012) were retrieved from the English Bowel
Cancer Screening Programme.
RESULTS: A total of 147,174 sub-centimeter
polyps were removed during 62,679 procedures. For pedunculated
polyps, hot snare was most common in the left (median 92 %, IQR 83.3-97.0 %) and right colon (median 75 %, IQR 3-92 %). For non-pedunculated
polyps, cold snare was most common in the right colon (median 24 %, IQR 9-47 %); whereas hot snare remained most common in the left colon (median 32 %, IQR 19-49 %). Surgeons were more likely than physicians to use
diathermy-assisted techniques (65.6 vs. 56.5 %, p < 0.001). Twelve (0.03 %)
bleeding episodes required transfusion with no polypectomy technique dominating and 16 (0.04 %) perforations with 81 % of polypectomies performed using
diathermy-assisted techniques. There was substantial variation between screening centers for the completeness of histological excision. For non-pedunculated
polyps, histologically confirmed complete excision was more after EMR (23.4 %) compared with other techniques (cold biopsy
forceps 17.7 %, cold snare 15.1 %, hot biopsy
forceps 19.1 %, hot snare 21.5 %). The use of cold techniques and EMR has increased over time, whereas the use of hot biopsy
forceps and hot snare has decreased (p < 0.001).
CONCLUSIONS: The removal of sub-centimeter
polyps within the BCSP is safe despite wide variations in practice. The use of cold resection techniques and EMR has increased over time. The histological assessment for completeness of excision is limited and should be confirmed endoscopically at the time of polypectomy.