A survey of colonoscopic polypectomy practices among clinical gastroenterologists.
BACKGROUND
Polypectomy techniques vary in clinical practice. The aim of this study was to determine patterns of polypectomy practices in a random sample of gastroenterologists.


METHODS
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.


RESULTS
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.


CONCLUSIONS
At present, polypectomy technique among clinical gastroenterologists is highly variable. Some newer ancillary techniques have had extremely limited use thus far.
Division of Gastroenterology, Department of Medicine, Indiana University School of Medicine, 550 University Boulevard, IU Hospital, Indianapolis, IN 46202, USA.
Navjot
N
Singh
Matthew
M
Harrison
Douglas K
DK
Rex
D003111:Colonic Polyps / Q000601:surgery*; D003113:Colonoscopy / Q000379:methods*; D003625:Data Collection; D004564:Electrocoagulation / Q000379:methods; D004598:Electrosurgery / Q000379:methods; D005762:Gastroenterology; D006801:Humans; D007267:Injections; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012494:Sampling Studies; D012965:Sodium Chloride / Q000008:administration & dosage; D013525:Surgical Instruments; D014481:United States
D012965:Sodium Chloride