title: The suction pseudopolyp technique: a novel method for the removal of small flat nonpolypoid lesions of the colon and rectum.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia.
authors.forename: V
authors.initials: V
authors.lastname: Pattullo
authors.forename: M J
authors.initials: MJ
authors.lastname: Bourke
authors.forename: K L
authors.initials: KL
authors.lastname: Tran
authors.forename: D
authors.initials: D
authors.lastname: McLeod
authors.forename: S J
authors.initials: SJ
authors.lastname: Williams
authors.forename: A A
authors.initials: AA
authors.lastname: Bailey
authors.forename: S
authors.initials: S
authors.lastname: Alexander
authors.forename: A
authors.initials: A
authors.lastname: Mishra
authors.forename: J
authors.initials: J
authors.lastname: Co
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000473:pathology / Q000601:surgery*; D003113:Colonoscopy / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D013396:Suction; D055815:Young Adult