The Suction Pseudopolyp Technique: A Novel Method For The Removal Of Small Flat Nonpolypoid Lesions Of The Colon And Rectum

Background and study aims: Small flat nonpolypoid lesions of the colorectum can be technically difficult to target and completely remove; techniques such as hot biopsy forceps electrocauterization are associated with serositis, delayed bleeding, and perforation. This study aimed to describe a novel technique for the removal of such lesions and demonstrate its safety and efficacy.Patients and methods: Patients aged 18-80 years with flat nonpolypoid lesions (Paris-Japanese classification 0-IIa and 0-IIb, measuring less than 10 mm) identified at colonoscopy were included in this prospective study. The lesions were removed by the suction pseudopolyp technique (SPT): the lesion is aspirated into the suction channel of the colonoscope and continuous suction applied for 5 seconds whilst the colonoscope is gently retracted. On release of the suction, the resulting pseudopolyp containing the lesion and a margin of normal tissue is easily ensnared and resected. The primary outcomes were endoscopic completeness of polyp resection and complication rate.Results: Over a 12-month period, 1231 polyps were removed during 2656 colonoscopies, 126 polyps (in 101 patients) met inclusion criteria. Complete endoscopic resection was achieved in 100% of the polyps, without immediate or delayed complication. Of the resected lesions, 57% had malignant potential (adenomas 47% and sessile serrated lesions 10%); a higher proportion of lesions removed from the right colon had malignant potential compared with those from the left colon (75% vs. 41%, P = 0.0066).Conclusions: Diminutive flat lesions of the colorectum are predominantly adenomas and sessile serrated lesions. SPT is a safe, effective, and reproducible therapy for removal of these lesions.