title: Quality of polyp resection during colonoscopy: are we achieving polyp clearance?
abstract: OBJECTIVE
  Currently colonoscopy quality indicators emphasize our ability to improve polyp detection (e.g., preparation quality, withdrawal times of ≥6 min). The completeness of a polyp resection may also be an important determinant of quality and efficient colonoscopy. The primary aim of this study was to determine the incidence of an incomplete polyp resection despite a perceived complete polypectomy.
  
  
  METHODS
  This was a retrospective quality assurance project conducted at the San Diego Veterans Affair Medical Center and University of California San Diego Medical Center from July 2007 to April 2008. The patients recruited to this study were undergoing surveillance and screening colonoscopy. The resection quality was evaluated in 65 polyps of 47 patients. Twenty-two polyps were removed with standard biopsy forceps, jumbo forceps (18), hot snare (18), and cold snare (7). Biopsies were taken from the post-polypectomy site base and perimeter for histologic examination in order to confirm histologic absence of all polypoid appearing mucosa.
  
  
  RESULTS
  The post-polypectomy sites of ten polyps (15%) were found to have residual polypoid tissue. Six were removed by standard biopsy forceps, jumbo forceps (2), hot snare (1), and cold snare (1). When compared to other polypectomy devices, standard biopsy forceps were more likely to result in an incomplete resection (27 vs. 9%; P = 0.076).
  
  
  CONCLUSIONS
  The endoscopist may not be visually accurate in determining when a polyp is completely resected, and alternative devices and techniques for polyp resection should be considered.
authors.affiliation: Gastroenterology, Department of Medicine, VA San Diego Healthcare System and University of California, San Diego, San Diego, CA 92161, USA.
authors.forename: Shanglei
authors.initials: S
authors.lastname: Liu
authors.forename: Samuel B
authors.initials: SB
authors.lastname: Ho
authors.forename: Mary Lee
authors.initials: ML
authors.lastname: Krinsky
mesh_terms: D000368:Aged; D003111:Colonic Polyps / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D003113:Colonoscopy / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011785:Quality Assurance, Health Care / Q000592:standards*; D012189:Retrospective Studies; D016896:Treatment Outcome