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World J Gastroenterol. May 7, 2023; 29(17): 2600-2615
Published online May 7, 2023. doi: 10.3748/wjg.v29.i17.2600
Difficult colorectal polypectomy: Technical tips and recent advances
Sukit Pattarajierapan, Hiroyuki Takamaru, Supakij Khomvilai
Sukit Pattarajierapan, Supakij Khomvilai, Surgical Endoscopy Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
Hiroyuki Takamaru, Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan
Author contributions: Pattarajierapan S wrote the article; Takamaru H and Khomvilai S made substantial contributions to the content, offered critical revisions, and approved the final version of the article.
Conflict-of-interest statement: The authors have no conflicts of interest or financial ties to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sukit Pattarajierapan, MD, Doctor, Surgeon, Surgical Endoscopy Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok 10330, Thailand. sukit.p@chulahospital.org
Received: January 29, 2023
Peer-review started: January 29, 2023
First decision: February 14, 2023
Revised: February 24, 2023
Accepted: April 12, 2023
Article in press: April 12, 2023
Published online: May 7, 2023
Core Tip

Core Tip: Most colorectal polyps are small and do not pose a significant challenge to resection. However, up to 15% of polyps are considered “difficult” because of their size, shape, or location. Advanced polypectomy techniques and skills are required for the resection of difficult colorectal polyps. Recent advancements in techniques and devices for endoscopic mucosal resection, endoscopic submucosal dissection, and endoscopic full-thickness resection allow curative therapy of these difficult polyps and avoid unnecessary surgery that carries the risk of morbidity and mortality. However, the proper selection of adjunct endoscopic devices/techniques and stepwise training for skill improvement are critical for successful advanced polypectomy.