Colonoscopic polypectomy

Colonoscopic polypectomy is the most effective visceral cancer prevention tool in clinical medicine. Two cohort studies have shown that polypectomy prevents colorectal cancer [1,2]. The National Polyp Study estimated that polypectomy prevented 76% to 90% of incident colorectal cancers (CRC), by comparing the rates of incident cancers after a clearing colonoscopy with the expected rates based on reference populations [1]. Another cohort of patients who had adenoma was calculated to incur an 80% reduction in incident CRC using similar methodology [2]. A randomized controlled trial comparing flexible sigmoidoscopy, with colonoscopy and polypectomy for any detected polyp, versus no screening reported an 80% reduction in CRC incidence in the screened group [3]. Colonoscopy is clearly imperfect in protecting against CRC, however [4]. Two studies have suggested that 27% to 31% of incident cancers after colonoscopy result from ineffective polypectomy [5,6]. All colonoscopists must therefore be highly proficient in polypectomy. Polypectomy has risks, however. The removal of any colon polyp should balance the likelihood that the polyp will turn into cancer with the risks associated with the technique used for its removal.