{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 30, Ep 2 of 5: Polyp Recognition and Resection Technique","html":"","width":"100%","height":180,"duration":837,"description":"Episode two frames polyp management as a reading task that begins before the snare opens: has the lesion grown horizontally along the mucosa or vertically into the submucosa, because vertical growth is what carries cancer risk. Paris morphology, the NICE and JNET optical patterns, Kudo pit pattern, and the lateral spreading granularity types are all ways of reading that same growth signal, and depressed or pseudodepressed surfaces are what deep submucosal invasion looks like from above. The optical read then dictates the resection plan. Cold snare wins on safety for diminutive and small lesions, hot snare is reserved for the vascularized pedunculated stalk, EMR is standard for larger sessile and lateral spreading lesions, and en bloc resection by ESD or band-ligation is reserved for when specimen integrity is needed for staging.\n \nTopics covered\n\nHorizontal versus vertical polyp growth\nParis morphology classification\nNICE and JNET optical prediction\nKudo pit pattern\nLateral spreading lesion granularity types\nCold snare and hot snare selection\nEndoscopic mucosal resection and the non-lifting sign\nUnderwater EMR and margin ablation\nESD and Japanese curative criteria\n \n \nKey decisions\n\nDepressed Paris zero-two-c and mixed zero-two-a-plus-c lesions carry disproportionately high submucosal invasion rates and go to en bloc resection or surgical referral, not piecemeal EMR.\nA NICE one or JNET one lesion can be confidently treated with cold-snare polypectomy, while a NICE three or JNET three lesion is a staging problem rather than an endoscopic one.\nCold snare polypectomy is preferred for diminutive polyps and standard for four to ten millimeter polyps because pure mechanical transection avoids thermal injury, dropping delayed bleeding and electrocoagulation syndrome.\nHot snare is reserved for pedunculated polyps over ten millimeters with a defined feeding artery, and thick stalks warrant a prophylactic clip or detachable loop before transection.\nFor sessile and lateral...","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}