Risk factors for incomplete polyp resection during colonoscopy

Abstract

Colonoscopic polypectomy is extremely effective in protecting against colorectal cancers, and recognition of adenomas by colonoscopy is of paramount importance in preventing colorectal cancer (CRC) and CRC-associated mortality. Incomplete polyp resection (IPR) occurs routinely in medical practice following polypectomy. We conducted a comprehensive literature search to identify studies that reported on the potential risk factors for IPR using MEDLINE, EMBASE, and PubMed. Publication time was limited between January 2004 and July 2021. Our search revealed assessments of the position, morphology, and histologic variation of the polyps—as well as the relevant skills that may interfere with IPR. The included studies showed that colonic polyps with a diameter >20 mm and proximal in location should be dealt with cautiously. For smaller polyps, cold-snare polypectomy appeared to be the most effective method used to accomplish comprehensive polyp removal. In addition, endoscopist experience in narrow-band imaging in polyp detection were also associated with IPR. Therefore, polypectomy should be performed cautiously if the polyp growth is expected to be cancerous and situated in the proximal portion of the colon or rectum, and modalities should be standardized so as to lower the potential risk for IPR.

Keywords

• Colon cancer
• Incomplete resection of polyp
• Incomplete endomucosal resection
• Colorectal polyps
• Colonoscopic polypectomy