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...
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ACG Postgraduate Course

Copyright 2012 ACG

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

1

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

% of total cohort

Classification

Is IIa IIb IIc or IIa+c Is+IIa

146 222 9 22 80 0

30.5 46.3 1.9 4.6 16.7 0

11 (7.5%) 9 (4.1%) 1 (11.1%) 0.001 7 (31.8%) 5 (6.3%) ( ) 0 (0%)

Surface morphology

Granular Non-Granular Mixed granular and non-granular Unable to classify

311 98 30

64.9 20.5 6.3

10 (3.2%) 15 (15%) 3 (10%)

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