Devices and techniques for endoscopic treatment of residual and fibrotic colorectal polyps (with videos)

Gastrointest Endosc. 2020 Sep;92(3):474-482. doi: 10.1016/j.gie.2020.03.018. Epub 2020 Jul 5.


Background and aims: Residual neoplasia after macroscopically complete EMR of large colon polyps has been reported in 10% to 32% of resections. Often, residual polyps at the site of prior polypectomy are fibrotic and nonlifting, making additional resection challenging.

Methods: This document reviews devices and methods for the endoscopic treatment of fibrotic and/or residual polyps. In addition, techniques reported to reduce the incidence of residual neoplasia after endoscopic resection are discussed.

Results: Descriptions of technologies and available outcomes data are summarized for argon plasma coagulation ablation, snare-tip coagulation, avulsion techniques, grasp-and-snare technique, EndoRotor endoscopic resection system, endoscopic full-thickness resection device, and salvage endoscopic submucosal dissection.

Conclusions: Several technologies and techniques discussed in this document may aid in the prevention and/or resection of fibrotic and nonlifting polyps.

MeSH terms

  • Colonic Polyps* / pathology
  • Colonic Polyps* / surgery
  • Colonoscopy
  • Colorectal Neoplasms / pathology
  • Colorectal Neoplasms / surgery
  • Endoscopic Mucosal Resection
  • Humans
  • Intestinal Mucosa / pathology
  • Neoplasm, Residual / pathology
  • Practice Guidelines as Topic