Detection and removal of flat polyps, large polyps and ugly polyps. Objectives and Disclosures
ACG Postgraduate Course
Copyright 2012 ACG
Detection and removal of flat polyps, large polyps and ugly polyps Steven A. Edmundowicz MD Chief of Endo...
Detection and removal of flat polyps, large polyps and ugly polyps Steven A. Edmundowicz MD Chief of Endoscopy Division of Gastroenterology Washington University School of Medicine St. Louis, Missouri
Objectives and Disclosures • Objectives – Discuss the terminology used in describing colorectal polyps and the risk of submucosal invasion of malignancy – Review the techniques for endoscopic management of difficult polyps – Review the management of polypectomy complications
• Disclosures related to this lecture – Grant and research support : Olympus, Cook Medical – Consultant: Boston Scientific Scientific, Olympus
October 2012
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ACG Postgraduate Course
Copyright 2012 ACG
Detection and removal of flat polyps, large polyps and ugly polyps • Assess the lesion – It is all about the prep – Risk of submucosal invasion – Which lesions to avoid
• Resection techniques: evidence based – Submucosal injection /Piecemeal resection – Techniques, devices evidence based approach – Margin g treatment/ Recurrence
• Recognizing and managing complications – Perforation: target sign, endoscopic closure – Bleeding: active and visible vessel treatment
Detection and removal of flat polyps, large polyps and ugly polyps • Assess the lesion – Risk of submucosal invasion – Which lesions to avoid
October 2012
2
ACG Postgraduate Course
Copyright 2012 ACG
Polyp characterization • • • •
Use the language Granular is “good” Depression is “bad” Pit patterns are complicated
Raised > 2.5mm
Raised < 2.5mm
October 2012
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ACG Postgraduate Course
Copyright 2012 ACG
Granular is Good • Granular = Good
• Non Granular = bad
Depression is Bad
October 2012
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ACG Postgraduate Course
Copyright 2012 ACG
Kudo’s Pit Pattern HYPERPLASTIC
ADENOMATOUS
CANCEROUS
• Prospective Study • 479 lesions > 20mm • 7 Australian Centers
October 2012
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ACG Postgraduate Course
Copyright 2012 ACG
Lesion characteristics and percentage with submucosal invasion N = 479 n