SAN DIEGO — A “suction pseudopolyp” technique is safe and effective for removing flat or nearly flat colorectal polyps, according to a study presented at the annual Digestive Disease Week.
In a case series involving 101 patients with a total of 126 small- and medium-sized flat polyps, the investigators were able to remove every polyp and retrieve 125 (99.2%) for histopathologic examination, said Dr. Venessa Pattullo of Westmead Hospital, Sydney, Australia.
The histology was definitive in all of the polyps that were retrieved, and the patients experienced no immediate or delayed complications, such as bleeding, perforation, or pain.
The pseudopolyp technique employs the suction channel of the colonoscope. Dr. Pattullo first aligns the suction channel with the center of the lesion. She then aspirates the lesion into the channel, maintaining continuous suction for 5 seconds as she withdraws the colonoscope a distance of 2-4 cm.
The result is a pseudopolyp containing both the flat lesion and some surrounding healthy tissue, all of which can easily be ensnared and removed with diathermy. This typically leaves clean cauterized edges and a clear margin, and carries little risk of transcolonic injury.
To be included, the patient's polyps had to fit into Paris classification 0-IIa (superficially elevated lesions) or 0-IIb (truly flat lesions). Patients were 18-80 years old, and the polyps were all less than 10 mm in diameter. The 101 patients and 126 flat polyps were part of a larger group of 2,640 colonoscopies during which 1,376 polyps were removed from 1,245 patients over a 12-month period.
Flat polyps are typically difficult to ensnare because there is no protuberant tissue to grab onto, Dr. Pattullo said. The traditional methods used to remove flat polyps have a number of shortcomings. For example, hot biopsy with electrocautery has been associated with a 16% complication rate. Cold biopsy often leaves residual adenoma.
Some colonoscopists “discount these diminutive lesions as clinically insignificant and [do] not attempt to remove them at all,” Dr. Pattullo said, describing this as an “unsatisfactory alternative.”
Dr. Pattullo said she had no conflicts of interest associated with her presentation.