Polyps & Polypectomy

Polyps occur throughout the GI tract and span benign hyperplastic mucosa, premalignant adenomas, serrated lesions, and frank carcinomas. Colonoscopic detection and removal of premalignant polyps is the central preventive intervention against colorectal cancer, and the diagnostic and technical sophistication of polypectomy continues to expand with the rise of endoscopic resection techniques.

Modern lesion classification combines morphology (Paris classification: pedunculated, sessile, flat, depressed) with surface pattern assessment (NICE, JNET, Kudo pit patterns) and size. Laterally spreading tumors (LSTs) are flat or slightly elevated lesions ≥10 mm that grow circumferentially rather than vertically — granular and non-granular subtypes carry different submucosal-invasion risks and resection strategies.

Resection technique is matched to lesion size and morphology. Cold snare polypectomy is preferred for diminutive (≤5 mm) and small (6–9 mm) lesions to minimize delayed bleeding and avoid deep thermal injury. Hot snare polypectomy or endoscopic mucosal resection (EMR) handles 10–20 mm lesions; piecemeal EMR or endoscopic submucosal dissection (ESD) is used for larger flat lesions. Tattooing the resection site with India ink (SPOT) is important for any lesion larger than 1 cm to allow precise relocalization on follow-up exam or surgery.