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.