How we resect colorectal polyps <20 mm in size

Abstract

We review our approach to resection of colorectal polyps <20 mm in size. Careful inspection of all lesions is appropriate to assess the type of lesion (adenoma vs serrated) and evaluate the risk of cancer, which is highly associated with lesion size. Polyp resection is in the midst of a “cold revolution,” particularly for lesions <10 mm in size, but also for some larger lesions. Cold forceps are sometimes appropriate for 1- to 2-mm lesions that can be engulfed in one bite, but we use cold snaring for almost the entire set of lesions <10 mm. For 10- to 19-mm conventional adenomas, we rely primarily on hot snare resection. Endoscopic mucosal resection (EMR), preferably en bloc, is appropriate for bulky nongranular conventional adenomas and nongranular adenomas with depression in this size range. For sessile serrated polyps 10 to 19 mm in size our approaches differ to some extent, with one of us using primarily “cold EMR,” and the other using primarily hot EMR technique.