“Studies show that polyp removal results in 75-percent to 90-percent reduction in cancer incidence," Lawrence said. “Polyps found in close proximity to colorectal cancer should be documented but not removed as they will most likely be included in the re-sected segment at surgery."
While physician preference for removal method is always evaluated, Lawrence said size is a deciding factor and anything less than 5 mm likely would be removed with biopsy forceps.
Single-bite biopsy forceps allow sampling of only a single specimen at a time. Multiple-bite forceps are equipped with a spike that can obtain up to four or more specimens on a single pass through the accessory channel, potentially contributing to decreased operative time when a large number of specimens are to be obtained.
“Single means one pass, a biopsy and drop," he added. “The multiple-bite forceps allow for taking multiple bites, dropping it in the trap and repeating the process. It makes a sizable difference in time efficiency as well as patient comfort."
Polypectomy snares come in a variety of shapes, sizes and materials, are marketed as disposable or reusable, and may be designed with special features.
“Once you get to 7 mm, people generally will use a snare," he said. “The rationale is that if you have a lesion of 8 mm, you can wrap your snare around that and squeeze the polyp into the snare with one fell swoop. The problem with using forceps with larger polyps is multiple pinching and a longer procedure time. There also is a higher risk of leaving some of the polyp behind, so it really has to do with complete removal in a more efficient fashion."
Biopsy isn't always an exact science, but best practices do exist, and should be followed.