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Abstract
Polypectomy techniques vary in clinical practice. The aim of this study was to determine
patterns of polypectomy practices in a random sample of gastroenterologists.
A total of 300 gastroenterologists were selected randomly from the membership directory
of a professional society. They were asked to complete a standardized survey by telephone,
electronic mail, or facsimile.
The offices of 285 physicians were contacted successfully. A total of 189 (63%) chose
to participate. 152 (80%) of these physicians were in private practice, and 37 (20%)
were in academic practice. The mean number of years in practice was 15.5 (range 1-46
years). Forceps techniques (cold or hot) dominated other polypectomy methods for polyps
1 to 3 mm in size ( p < 0.0001), whereas electrosurgical snare resection was dominate
for polyps 7 to 9 mm in diameter ( p < 0.0001). No method of polypectomy was significantly
more likely to be used for polyps 4 to 6 mm in size. The proportion of physicians
who had used dye spraying was 8.5%; detachable snares, 20.1%; clips, 20.1%; and submucosal
saline solution injection, 82%. Of those who had used submucosal saline solution injection,
29.7% had no rules for its use, and, in the remainder, there was marked variation
regarding the criteria. For polyp stalks greater than 1 cm in diameter, 69% used no
method to prevent bleeding. Of those who did use preventive techniques, 76% used epinephrine
injection. The electrosurgical current used for polypectomy was pure coagulation in
46%, blend in 46%, and pure-cut in 3%; 4% varied the current.
At present, polypectomy technique among clinical gastroenterologists is highly variable.
Some newer ancillary techniques have had extremely limited use thus far.