Endoscopic Polypectomy: Clinical Protocol and Best Practices

Pre-Procedure Assessment

Patient Evaluation

• Review complete medical history
• Assess anticoagulation status
• Evaluate comorbidities
• Review imaging and previous endoscopy reports

Equipment Preparation

• Snares (various sizes)
• Hot and cold biopsy forceps
• Injection needles (23-25 gauge)
• Hemoclips
• Retrieval devices

Procedure Steps

1. Initial Assessment

• Document polyp characteristics:
  • Size
  • Morphology (Paris classification)
  • Surface pattern
  • Location

2. Technique Selection

Cold Snare Polypectomy

• Indicated for polyps ≤10mm
• No electrocautery required
• Reduced risk of delayed bleeding

Hot Snare Polypectomy

• For polyps >10mm
• Electrocautery settings:
  • ENDO CUT Q: Effect 3
  • Duration 1, Interval 6

3. Execution

1. Position polyp at 5-6 o'clock
2. Place snare wire around polyp
3. Ensure 1-2mm margin of normal mucosa
4. Close snare slowly and verify tissue capture
5. Remove specimen

Post-Procedure

Specimen Handling

• Label specimens separately
• Document retrieval method
• Submit to pathology in formalin

Documentation Requirements

• Polyp characteristics
• Removal technique
• Complications
• Retrieved specimen details

Complications Management

Immediate

• Bleeding: Implement hemostasis protocol
• Perforation: Assess for clip closure

Delayed

• Post-polypectomy syndrome
• Delayed bleeding
• Monitor for 14 days

Quality Metrics

• Complete retrieval rate
• Clean resection margins
• Complication rates
• Follow-up compliance