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• W4238607789 abstract "The ASGE Technology Committee provides reviews of existing, new, or emerging endoscopic technologies that have an impact on the practice of gastrointestinal endoscopy. Evidence-based methodology is employed, using a MEDLINE literature search to identify pertinent clinical studies on the topic and a MAUDE (Food and Drug Administration Center for Devices and Radiological Health) database search to identify the reported complications of a given technology. Both are supplemented by accessing the “related articles” feature of PubMed and by scrutinizing pertinent references cited by the identified studies. Controlled clinical trials are emphasized, but in many cases data from randomized controlled trials are lacking. In such cases, large case series, preliminary clinical studies, and expert opinions are utilized. Technical data are gathered from traditional and Web-based publications, proprietary publications, and informal communications with pertinent vendors. Technology Status Evaluation Reports are drafted by 1 or 2 members of the ASGE Technology Committee, reviewed and edited by the committee as a whole, and approved by the Governing Board of the ASGE. When financial guidance is indicated, the most recent coding data and list prices at the time of publication are provided. For this review the MEDLINE database was searched through January 2007 for articles related to “polypectomy” and “colonoscopy” crossed with “snare,” “bipolar snare,” “biopsy,” “hot biopsy,” “endoloop,” “submucosal injection,” and “hemoclip.” Technology Status Evaluation Reports are scientific reviews provided, solely for educational and informational purposes. Technology Status Evaluation Reports are not rules and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment or payment for such treatment. Mucosal polyps are commonly discovered during endoscopic evaluation of the GI tract. Adenomatous polyps are at risk for progression to carcinoma, hence their identification and removal is a primary goal of endoscopy. Polyps come in a wide variety of shapes and sizes, and may be positioned in challenging locations for removal. A variety of techniques and devices are available to the endoscopist to accomplish the safe removal of polyps. Familiarity with available polypectomy devices is important for their optimal selection and safe use. This status evaluation will describe the devices and the agents available for the performance of endoscopic polypectomy. The goals of polypectomy generally include both representative sampling and the safe removal or ablation of the entire lesion. Sampling can be performed via prior cold biopsy, concurrent biopsy and ablation, or retrieval of tissue after excision. Polyp removal can be accomplished via “cold” mechanical cutting without the use of cautery or with concurrent application of electrocautery for ablation and hemostasis. The electrosurgical generators used for the performance of polypectomy were recently reviewed.1Slivka A. Bosco J. Barkun A. et al.Electrosurgical generators.Gastrointest Endosc. 2003; 58: 656-660Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar A number of technologies and numerous devices are available for polypectomy (Appendix, Tables 1 and 2). Electrosurgical polypectomy devices attach to electrosurgical generators with several different active cord-connector designs. When purchasing electrosurgical snares and hot biopsy forceps (HBF), one must ensure compatibility of components. Biopsy forceps used for polypectomy include both standard “cold” biopsy devices and “hot biopsy” devices that serve as an electrode for simultaneous tissue biopsy and electrocautery. Both varieties are sold as single-use or reusable devices. Cold biopsy forceps have been reviewed in separate documents: Endoscopic Tissue Sampling Devices2Barkun A. Liu J. Carpenter S. et al.ASGE technology status evaluation report: endoscopic tissue sampling devices.Gastrointest Endosc. 2006; 63: 743-747Abstract Full Text Full Text PDF Scopus (31) Google Scholar and Tissue Sampling and Analysis.3Faigel D. Eisen G. Baron T. et al.Tissue sampling and analysis.Gastrointest Endosc. 2003; 57: 811-816Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar Polypectomy with HBF theoretically provides improved hemostasis and more complete ablation of the neoplastic tissue. Both monopolar and bipolar variants have been described. Monopolar forceps, which are most common, use the application of electrocautery via the 2 biopsy cups in contact with the polyp, with the return current passing through the patient's body to a distant return electrode or a ground pad. The most effective technique is to grasp the polyp superficially in the forceps, tent the mucosa, and judiciously apply energy to achieve a white coagulum adjacent to the forceps. In the bipolar design, the 2 opposing cups of the forceps serve as opposite electrodes, such that electrocautery is primarily applied to the tissue caught within the bite of the device, and its penetration within neighboring tissue is extremely shallow. Polypectomy snares incorporate a monopolar wire loop electrode that is advanced beyond a plastic insulating catheter to encircle the target tissue, which is then transected via mechanical and electrosurgical cutting as the loop is withdrawn into the catheter. Snares are made of monofilament or braided wires of various gauges. The catheters vary in caliber and length to accommodate application through all lengths and calibers of endoscope channel. All snares are designed for use with electrocautery, but either hot or cold techniques can be used with any device. Small or mini monofilament snares are commonly used in the cold technique. Both single-use and reusable varieties are available. Snares are made in a wide variety of sizes and shapes designed to match the anatomic requirements for ensnaring a given lesion. Endoscopic bipolar snares have been designed and studied but are not readily available.4Tucker R.D. Platz C.E. Sievert C.E. et al.In vivo evaluation of monopolar versus bipolar electrosurgical polypectomy snares.Am J Gastroenterol. 1990; 85: 1386-1390PubMed Google Scholar Rotatable snares allow the assistant to change the orientation of the wire loop relative to the lesion.5Yang R. Mabansag R. Laine L. Rotatable polypectomy snares: a randomized, prospective comparison with standard snares.Gastrointest Endosc. 2003; 57 ([abstract]): T1480Google Scholar Barbed- and needle-tip snares facilitate positioning and grasping of tissue at the base of polyps. Combination devices incorporating snares with injection needles or other modalities are being designed. Submucosal injection of a liquid medium can elevate the target lesion to facilitate removal and to limit the depth of thermal injury to the gut wall by increasing the distance between burn and serosa. Saline solution cushions rapidly disperse into neighboring tissue planes, hence, a variety of injectable agents, including 50% dextrose, glycerol, dilute hyaluronic acid, and methylcellulose, have been evaluated for their ease of injection and duration of cushion effect.6Feitoza A.B. Gostout C.J. Burgart L.J. et al.Hydroxypropyl methylcellulose: a better submucosal fluid cushion for endoscopic mucosal resection.Gastrointest Endosc. 2003; 57: 41-47Abstract Full Text Full Text PDF PubMed Scopus (125) Google Scholar, 7Conio M. Rajan E. Sorbi D. et al.Comparative performance in the porcine esophagus of different solutions used for submucosal injection.Gastrointest Endosc. 2002; 56: 513-516Abstract Full Text Full Text PDF PubMed Google Scholar Other occasional additives include epinephrine for hemostasis and methylene blue for demarcation of the polyp margins.8Dobrowolski S. Dobosz M. Babicki A. et al.Prophylactic submucosal saline-adrenaline injection in colonoscopic polypectomy: prospective randomized study.Surg Endosc. 2004; 18: 990-993Crossref PubMed Scopus (94) Google Scholar Dextrose 50% is readily available and produces a longer-lasting submucosal bleb than saline solution.9Conio M. Rajan E. Sorbi D. et al.Comparative performance in the porcine esophagus of different solutions used for submucosal injection.Gastrointest Endosc. 2002; 56: 513-516Abstract Full Text Full Text PDF PubMed Scopus (81) Google Scholar In a comparative study of agents for submucosal injection during the performance of esophageal EMR, the dispersal and the loss of an appreciable submucosal cushion was compared for saline solution, saline solution plus epinephrine, 50% dextrose, 10% glycerine and 5% fructose, and 1% hyaluronic acid.7Conio M. Rajan E. Sorbi D. et al.Comparative performance in the porcine esophagus of different solutions used for submucosal injection.Gastrointest Endosc. 2002; 56: 513-516Abstract Full Text Full Text PDF PubMed Google Scholar The “disappearance time” was significantly shorter for saline solution and saline solution plus epinephrine compared with all other agents. Hyaluronic acid was retained far longer (median, 22 minutes) than all other agents. Subsequent studies of hydroxypropyl methylcellulose yielded prolonged disappearance times similar to those for hyaluronic acid (36-38 minutes).6Feitoza A.B. Gostout C.J. Burgart L.J. et al.Hydroxypropyl methylcellulose: a better submucosal fluid cushion for endoscopic mucosal resection.Gastrointest Endosc. 2003; 57: 41-47Abstract Full Text Full Text PDF PubMed Scopus (125) Google Scholar Ancillary devices for the performance of polypectomy include retrieval accessories for efficient capture of multiple polyp fragments after colonoscopic polypectomy,10Miller K. Waye J.D. Polyp retrieval after colonoscopic polypectomy: use of the Roth retrieval net.Gastrointest Endosc. 2001; 54: 505-507Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar, 11Nelson D.B. Bosco J.J. Curtis W.D. et al.Endoscopic retrieval devices.Gastrointest Endosc. 1999; 50: 932-934Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar injection needles,12Nelson D. Bosco B. Curtis W. et al.ASGE technology status report: injection needles.Gastrointest Endosc. 1999; 50: 928-931Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar hemostasis clips,13Chuttani R. Barkun A. Carpenter S. et al.ASGE technology status report: endoscopic clip application devices.Gastrointest Endosc. 2006; 63: 746-750Abstract Full Text Full Text PDF PubMed Scopus (86) Google Scholar detachable snares,14Iishi H. Tatsuta M. Narahara H. et al.Endoscopic resection of large pedunculated colorectal polyps using a detachable snare.Gastrointest Endosc. 1996; 44: 594-597Abstract Full Text Full Text PDF PubMed Scopus (129) Google Scholar mucosal resection caps,15Nelson D. Block D. Bosco J. et al.ASGE technology status evaluation report: endoscopic mucosal resection.Gastrointest Endosc. 2000; 52: 860-863Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar and varied ablation accessories (eg, monopolar and bipolar probes,16Nelson D. Barkun A. Block K. et al.ASGE technology status report: endoscopic hemostatic devices.Gastrointest Endosc. 2001; 54: 833-840Abstract Full Text Full Text PDF PubMed Google Scholar argon coagulation devices17Ginsberg G. Barkun A. Bosco J. et al.ASGE technology status evaluation report: the argon plasma coagulator.Gastrointest Endosc. 2002; 55: 807-810Abstract Full Text Full Text PDF PubMed Scopus (137) Google Scholar, 18Vargo J. Technology review: clinical applications of the argon plasma coagulator.Gastrointest Endosc. 2004; 59: 81-88Abstract Full Text Full Text PDF PubMed Scopus (163) Google Scholar and lasers).19Carr-Locke D.L. Conn M.I. Faigel D.O. et al.Status evaluation report: developments in laser technology.Gastrointest Endosc. 1997; 48: 711-716Google Scholar A number of these devices are further reviewed in other technology status evaluation reports.11Nelson D.B. Bosco J.J. Curtis W.D. et al.Endoscopic retrieval devices.Gastrointest Endosc. 1999; 50: 932-934Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar, 12Nelson D. Bosco B. Curtis W. et al.ASGE technology status report: injection needles.Gastrointest Endosc. 1999; 50: 928-931Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar, 13Chuttani R. Barkun A. Carpenter S. et al.ASGE technology status report: endoscopic clip application devices.Gastrointest Endosc. 2006; 63: 746-750Abstract Full Text Full Text PDF PubMed Scopus (86) Google Scholar, 15Nelson D. Block D. Bosco J. et al.ASGE technology status evaluation report: endoscopic mucosal resection.Gastrointest Endosc. 2000; 52: 860-863Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar, 17Ginsberg G. Barkun A. Bosco J. et al.ASGE technology status evaluation report: the argon plasma coagulator.Gastrointest Endosc. 2002; 55: 807-810Abstract Full Text Full Text PDF PubMed Scopus (137) Google Scholar, 19Carr-Locke D.L. Conn M.I. Faigel D.O. et al.Status evaluation report: developments in laser technology.Gastrointest Endosc. 1997; 48: 711-716Google Scholar Argon coagulation is a noncontact method of delivering high-frequency monopolar current through ionized and electrically conductive argon gas. Currently, 2 endoscopic systems are available (Conmed, Utica, NY, and ERBE USA, Marietta, Ga). Argon electrocautery devices are commonly used for ablation of neoplastic tissues, including residual tissue after performance of piecemeal polypectomy or EMR. Devices designed to ensure hemostasis include endoscopic clips and the detachable loop ligating device. Clips and endoloops have been used to clamp or to ensnare the base or the stalk of large polyps before and after polypectomy. Clips are also used to close mucosal defects after resection. Several proprietary clip designs are available in preloaded and nonloaded versions.20Raju G.S. Gajula L. Technological review: endoclips for GI endoscopy.Gastrointest Endosc. 2004; 59: 267-279Abstract Full Text Full Text PDF PubMed Scopus (173) Google Scholar The detachable loop-ligating device is a nylon noose with a sliding hub that can be cinched to reduce and fix the size of the loop. They are available in 20-mm and 30-mm loop sizes, and are delivered and positioned via a catheter of varied sheath lengths. A loop cutter is available for removing part or all of deployed loops. Endoscopic polypectomy is nearly universally effective for pedunculated lesions but is highly size, technique, and experience related for sessile lesions. Data on the efficacy and risks of polypectomy related to individual techniques are cited below, where available. In 1 study, snare polypectomy of 68 colon polyps larger than 30 mm achieved complete resection in 1 procedure for 82% of sessile lesions and for all of the pedunculated lesions.21Stergiou N. Riphaus A. Lange P. et al.Endoscopic snare resection of large colonic polyps: how far can we go?.Int J Colorectal Dis. 2003; 18: 131-135Crossref PubMed Scopus (40) Google Scholar Overall, postpolypectomy hemorrhage has been noted in 0.85% to 2.7% of all polypectomies,22Silvis S.E. Nebel O. Rogers G. et al.Endoscopic complications: results of the 1974 American Society for Gastrointestinal Endoscopy survey.JAMA. 1976; 235: 928-930Crossref PubMed Scopus (623) Google Scholar, 23Macrae F. Tan K. Williams C. Towards safer colonoscopy: a report on the complications of 5000 diagnostic or therapeutic colonoscopies.Gut. 1983; 24: 376-383Crossref PubMed Scopus (433) Google Scholar, 24Webb W. McDaniel L. Jones L. Experience with 1000 colonoscopic polypectomies.Ann Surg. 1985; 201: 626-632Crossref PubMed Scopus (98) Google Scholar, 25Complications of colonoscopy ASGE standards of practice report.Gastrointest Endosc. 2003; 57: 441-445Abstract Full Text PDF PubMed Scopus (152) Google Scholar with the majority being delayed in presentation26Waye J. Lewis B. Yessayan S. Colonoscopy: a prospective report of complications.J Clin Gastroenterol. 1992; 15: 347-351Crossref PubMed Scopus (352) Google Scholar and the minority requiring transfusions.27Matsui Y. Inomata M. Izumi K. et al.Hyaluronic acid stimulates tumor-cell proliferation at wound sites.Gastrointest Endosc. 2004; 60: 539-543Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar Electrocoagulation injury to the bowel wall has been reported to induce a transmural burn in approximately 0.51% to 1.2% of patients undergoing polypectomy, often resulting in the “postpolypectomy syndrome” of localized inflammation and pain, without evidence of perforation.28Zlatanic J. Waye J.D. Kim P.S. et al.Large sessile colonic adenomas: use of argon plasma coagulator to supplement piecemeal snare polypectomy.Gastrointest Endosc. 1999; 49: 731-735Abstract Full Text Full Text PDF PubMed Scopus (182) Google Scholar, 29Regula J. Wronska E. Polkowski M. et al.Argon plasma coagulation after piecemeal polypectomy of sessile colorectal adenomas: long-term follow-up study.Endoscopy. 2003; 35: 212-218Crossref PubMed Scopus (127) Google Scholar In an effort to avoid this effect, polypectomy with pure-cutting current was studied.30Parra-Blanco A. Kaminaga N. Kojima T. et al.Colonoscopic polypectomy with cutting current: is it safe?.Gastrointest Endosc. 2000; 51: 676-681Abstract Full Text Full Text PDF PubMed Scopus (92) Google Scholar A bleeding rate comparable with that seen with the use of coagulation or blended current was noted, provided that hemoclip placement can be used readily, as needed. There does not appear to be a risk-based size limit for polypectomy, though postpolypectomy bleeding is more common (12%-24%) after removal of large lesions with standard techniques.21Stergiou N. Riphaus A. Lange P. et al.Endoscopic snare resection of large colonic polyps: how far can we go?.Int J Colorectal Dis. 2003; 18: 131-135Crossref PubMed Scopus (40) Google Scholar, 31Binmoeller K.F. Bohnacker S. Seifert H. et al.Endoscopic snare excision of “giant” colorectal polyps.Gastrointest Endosc. 1996; 43: 183-188Abstract Full Text Full Text PDF PubMed Scopus (193) Google Scholar Almost all bleeding episodes are manageable by endoscopic techniques. Evolving techniques for EMR of broad flat lesions are beyond the scope of this review and have recently been addressed.15Nelson D. Block D. Bosco J. et al.ASGE technology status evaluation report: endoscopic mucosal resection.Gastrointest Endosc. 2000; 52: 860-863Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar Removal of diminutive polyps (<5 mm) via single or serial cold biopsies is attractive because of the perceived safety of the technique; however, concerns exist regarding adequacy of polyp ablation. In 1 study of cold biopsy excision of diminutive colon polyps, 29% of patients had residual neoplastic tissue detected 3 weeks after treatment.32Woods A. Sanowski R.A. Wadas D.D. et al.Eradication of diminutive polyps: a prospective evaluation of bipolar coagulation versus conventional biopsy removal.Gastrointest Endosc. 1989; 35: 536-540Abstract Full Text PDF PubMed Scopus (70) Google Scholar Similarly, in a study of 62 diminutive polyps treated by HBF, 17% had persistent viable polyp tissue on repeat endoscopic evaluation 2 weeks after therapy.33Peluso F. Goldner F. Follow-up of hot biopsy forceps treatment of diminutive colonic polyps.Gastrointest Endosc. 1991; 37: 604-606Abstract Full Text PDF PubMed Scopus (81) Google Scholar In a canine study, monopolar HBF caused transmural injury significantly more often than did bipolar HBF (44% vs 5%, respectively).34Savides T.J. See J.A. Jensen D.M. et al.Randomized controlled study of injury in the canine right colon from simultaneous biopsy and coagulation with different hot biopsy forceps.Gastrointest Endosc. 1995; 42: 573-578Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar A porcine study of injury from various polypectomy devices showed that the HBF yielded consistently deeper tissue injury than that produced with a snare.35Chino A. Karasawa T. Uragami N. et al.A comparison of depth of tissue injury caused by different modes of electrosurgical current in a pig colon model.Gastrointest Endosc. 2004; 59: 374-379Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar Hot biopsy polypectomy may carry greater risk in the right colon, because 17 of 19 perforations identified in a survey of complications occurred in this region.3Faigel D. Eisen G. Baron T. et al.Tissue sampling and analysis.Gastrointest Endosc. 2003; 57: 811-816Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar, 36Wadas D.D. Sanowski R.A. Complications of the hot biopsy forceps technique.Gastrointest Endosc. 1988; 34 ([abstract]): 32-37Abstract Full Text PDF PubMed Scopus (127) Google Scholar Factors that seemed to impact the frequency of complications were the degree and the length of current application. However, a series of 907 small polyps (2-8 mm) removed with HBF in 460 patients showed no complications.37Mann N.S. Mann S.K. Alam I. The safety of hot biopsy forceps in the removal of small colonic polyps.Digestion. 1999; 60: 74-76Crossref PubMed Scopus (29) Google Scholar There are limited data on the outcomes of polypectomy when using the various snare techniques and designs. Cold snare polypectomy of 288 diminutive polyps was performed without complication in 210 patients without coagulopathy.38Tappero G. Gaia E. De Giuli P. et al.Cold snare excision of small colorectal polyps.Gastrointest Endosc. 1992; 38: 310-313Abstract Full Text PDF PubMed Scopus (147) Google Scholar Mini-snares (11-13 mm wide), used with or without electrocautery, proved effective in removing 94% of small (2-7 mm) polyps in 90 patients. There was 1 major hemorrhage (0.5%) after polypectomy, without use of electrocautery.39McAfee J.H. Katon R.M. Tiny snares prove safe and effective for removal of diminutive colorectal polyps.Gastrointest Endosc. 1994; 40: 301-303Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar Of note, 12% of the tissue specimens were not retrieved. Compared with snares of standard design, rotatable snares were found to ease polyp snaring and to reduce procedure time.5Yang R. Mabansag R. Laine L. Rotatable polypectomy snares: a randomized, prospective comparison with standard snares.Gastrointest Endosc. 2003; 57 ([abstract]): T1480Google Scholar A porcine study showed that submucosal injection of saline solution significantly reduced the proportions of lesions with deep tissue injury from argon coagulation and thermal probes. However, injection did not alter the deep tissue injury after HBF.40Norton I.D. Wong L. Levine S.A. et al.Efficacy of colonic submucosal saline solution injection for the reduction of iatrogenic thermal injury.Gastrointest Endosc. 2002; 56: 95-99Abstract Full Text Full Text PDF PubMed Scopus (94) Google Scholar Several clinical reports have documented the safety and the utility of saline-solution–assisted polypectomy.14Iishi H. Tatsuta M. Narahara H. et al.Endoscopic resection of large pedunculated colorectal polyps using a detachable snare.Gastrointest Endosc. 1996; 44: 594-597Abstract Full Text Full Text PDF PubMed Scopus (129) Google Scholar, 41Shirai M. Nakamura T. Matsuura A. et al.Safer colonoscopic polypectomy with local submucosal injection of hypertonic saline-epinephrine solution.Am J Gastroenterol. 1994; 89: 334-338PubMed Google Scholar, 42Iishi H. Tatsuta M. Kitamura S. et al.Endoscopic resection of large sessile colorectal polyps using a submucosal saline injection technique.Hepatogastroenterology. 1997; 44: 698-702PubMed Google Scholar, 43Miros M. Removing large sessile polyps with saline assisted technique and diminutive polyps with a cold snare reduces the risks of complications to less than 1 per 1000 polypectomies.Gastrointest Endosc. 2000; 51 ([abstract]): A3349Google Scholar In a randomized controlled trial of epinephrine injection before removal of 100 polyps >1 cm in diameter in 69 patients, only 1 of 50 bled after treatment vs 8 of 50 without injection (P < .05).8Dobrowolski S. Dobosz M. Babicki A. et al.Prophylactic submucosal saline-adrenaline injection in colonoscopic polypectomy: prospective randomized study.Surg Endosc. 2004; 18: 990-993Crossref PubMed Scopus (94) Google Scholar In a study that compared injectants for endoscopic removal of large sessile colorectal polyps, glycerol yielded more complete resections (45.5% vs 25%) and more en bloc resections (64% vs 49%) than did saline solution, used in the historical control patients.44Uraoka T. Fujii T. Saito Y. et al.Effectiveness of glycerol as a submucosal injection for EMR.Gastrointest Endosc. 2005; 61: 736-740Abstract Full Text Full Text PDF PubMed Scopus (160) Google Scholar Bacteremia associated with saline-solution–assisted polypectomy has been reported.45Ono Y. Munakata A. Bacteremia after saline-assisted polypectomy.Gastrointest Endosc. 1997; 46: 279-281Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar Animal studies have suggested that some injectants may cause local tissue inflammation25Complications of colonoscopy ASGE standards of practice report.Gastrointest Endosc. 2003; 57: 441-445Abstract Full Text PDF PubMed Scopus (152) Google Scholar or may induce tumor growth,27Matsui Y. Inomata M. Izumi K. et al.Hyaluronic acid stimulates tumor-cell proliferation at wound sites.Gastrointest Endosc. 2004; 60: 539-543Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar but the clinical relevance of these observations is uncertain. Ionized argon coagulation of known or potential residual adenoma after polypectomy has been shown to significantly reduce28Zlatanic J. Waye J.D. Kim P.S. et al.Large sessile colonic adenomas: use of argon plasma coagulator to supplement piecemeal snare polypectomy.Gastrointest Endosc. 1999; 49: 731-735Abstract Full Text Full Text PDF PubMed Scopus (182) Google Scholar, 46Brooker J. Saunders B. Shah S. et al.Treatment with argon plasma coagulation reduces recurrence after piecemeal resection of large sessile colonic polyps: a randomized trial and recommendations.Gastrointest Endosc. 2002; 55: 371-375Abstract Full Text Full Text PDF PubMed Scopus (252) Google Scholar or have no effect29Regula J. Wronska E. Polkowski M. et al.Argon plasma coagulation after piecemeal polypectomy of sessile colorectal adenomas: long-term follow-up study.Endoscopy. 2003; 35: 212-218Crossref PubMed Scopus (127) Google Scholar on the rate of persistent adenoma at follow-up examination. Although efficient and apparently safer than alternative means for ablating residual adenomatous tissue, argon coagulation therapy has a potential for transmural injury and perforation.17Ginsberg G. Barkun A. Bosco J. et al.ASGE technology status evaluation report: the argon plasma coagulator.Gastrointest Endosc. 2002; 55: 807-810Abstract Full Text Full Text PDF PubMed Scopus (137) Google Scholar Endoscopic clips have been used with a goal of preventing immediate and delayed postpolypectomy bleeding. They have been applied to the stalk of polyps before resection or after polyp removal.47Abou-Assi S.G. Mihas A.A. Joseph R.M. et al.Endoscopic hemoclip application for the treatment of a large gastric polyp causing intermittent outlet obstruction.Gastrointest Endosc. 2003; 57: 433-435Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar However, randomized studies of clip application after EMR of gastric lesions or polypectomy of colon polyps have found no benefit.48Shioji K. Suzuki Y. Kobayashi M. et al.Prophylactic clip application does not decrease delayed bleeding after colonoscopic polypectomy.Gastrointest Endosc. 2003; 57: 691-694Abstract Full Text Full Text PDF PubMed Scopus (208) Google Scholar In a prospective randomized trial that compared snare polypectomy to endoloop-aided snare resection of large pedunculated polyps in 87 patients, the endoloop yielded a significant reduction in postpolypectomy bleeding (12% vs 0%; P < .05).14Iishi H. Tatsuta M. Narahara H. et al.Endoscopic resection of large pedunculated colorectal polyps using a detachable snare.Gastrointest Endosc. 1996; 44: 594-597Abstract Full Text Full Text PDF PubMed Scopus (129) Google Scholar The Current Procedural Terminology (CPT) codes for colonoscopy and polypectomy are referenced in Table 1. In general, when 1 polyp or multiple polyps are treated at the time of colonoscopy, 1 code is reported to reflect 1 technique. However, if different techniques are utilized to remove different lesions at different sites, different primary and secondary codes can be reported, utilizing -59 modifier on the second or subsequent code. Likewise, if submucosal injection is performed (45381), it can be separately reported as a secondary procedure, again with -59 modifier.Table 1CPT codes for performance of polypectomyCPT codeColonoscopy with biopsy, single or multiple45380Colonoscopy with removal of lesions by hot biopsy45384Colonoscopy with removal of lesions by snare45385Colonoscopy with ablation of lesions not by hot biopsy/snare45383Colonoscopy with injection of any substance45381Sigmoidoscopy with biopsy, single or multiple45331Sigmoidoscopy with removal of lesions by hot biopsy45333Sigmoidoscopy, flexible; with directed submucosal injection(s), any substance45335Sigmoidoscopy with removal of lesions by snare45338Sigmoidoscopy with ablation of lesions by other means45339Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with biopsy, single or multiple44361Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique44364 Open table in a new tab The prices of both single use and reusable devices have dropped considerably in recent years. Managers must decide whether to use disposable or reusable accessories in their respective units. A recent technology report on single-use devices provides guidance regarding considerations of cost, reprocessing, and frequency of use.49Croffie J. Carpenter S. Chuttani R. et al.ASGE technology status evaluation report: disposable endoscopic accessories.Gastrointest Endosc. 2005; 62: 477-479Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar There is a wide variety of devices available for endoscopic polyp sampling, removal, or ablation. The development of new techniques and accessories has led to the safe application of polypectomy for a broader group of patients with larger and more difficult lesions.50Waye J.D. New methods of polypectomy.Gastrointest Endosc Clin N Am. 1997; 7: 413-422PubMed Google Scholar Ongoing review and familiarity with advances in polypectomy devices and techniques will benefit the practicing endoscopist." @default.
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• W4238607789 title "Polypectomy devices" @default.
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