Advanced Endoscopic Procedures Research Articles

Advancements in Early Detection and Screening Strategies for Pancreatic Cancer: From Genetic Susceptibility to Novel Biomarkers.

Pancreatic cancer is a rare but lethal cancer due to its biologically aggressive nature, advanced stage at the time of diagnosis, and poor response to oncologic therapies. The risk of pancreatic cancer is significantly higher to 5% in certain high-risk individuals with inherited genetic susceptibility. Screening for pancreatic cancer in these individuals from high-risk groups can help with the early detection of pancreatic cancer as well as the detection of precursor lesions leading to early surgical resection and improved overall outcomes. The advancements in radiological imaging as well as advanced endoscopic procedures has made a significant impact on the early diagnosis, surveillance, and staging of pancreatic cancer. There is also a significant advancement in the development of biomarkers for the early detection of pancreatic cancer, which has also led to the development of liquid biopsy, allowing for microRNA detection in serum and circulating tumor cells. Various societies and organizations have provided guidelines for pancreatic cancer screening and surveillance in high-risk individuals. In this review, we aim to discuss the hereditary risk factors for developing pancreatic cancer, summarize the screening recommendations by different societies, and discuss the development of novel biomarkers and areas for future research in pancreatic cancer screening for high-risk individuals.

Twenty First Century Technological Toolbox Innovation for Transanal Minimally Invasive Surgery (TAMIS).

Transanal minimally invasive surgery (TAMIS) is an effective procedure that plays an important role in the care of patients with significant rectal neoplasia and polyps including early-stage cancers. However, it is perhaps underutilised and under threat from both advanced flexible endoscopic procedures and proceduralists (who often act as gatekeepers for referral to colorectal surgeons), as well as from robotic surgery proponents. TAMIS advocates can learn and adopt practice insights from both these fields and incorporate available technological innovations building on the huge accomplishments already delivered in this area. Evolved practice through technology has the potential to offset current limitations regarding technical constraints and indeed patient selection (via artificial intelligence methods). Potential target areas for advances are considered in this review from different perspectives: (1) Access (2) Insufflation (3) Visualisation (4) Disease Characterization in situ, and (5) Tissue Handling and Suturing. While a bundle approach may be most useful, the advances for each component are potentially useful in their own right and could be applied without depending on the other practices detailed so that more accurate (and perhaps even numerically more) TAMIS procedures can be performed globally to improve patient care.

Reimbursement and tips and tricks to make endoluminal surgery profitable

Advanced endoscopic procedures require a complex skillset to remove larger, benign and early malignant lesions within the colon and rectum. These procedures require large amounts of resources and have costs associated with them. They also are associated with huge benefits to the patient and cost savings when compared to colon resection as an alternative. Maximizing reimbursement and ensuring sustainability of these techniques requires a thoughtful approach to implement into everyday practice. This manuscript explores these issues in greater depth.

Endoscopy ergonomics: a survey-based study exploring gender differences

Women, on average, have smaller hand sizes as well as lower muscle mass and strength. With the increasing number of women entering training programs in gastroenterology, our aim was to study the subtle gender differences in endoscopy ergonomics. A survey instrument regarding demographic information, personal preferences in endoscopy styles and techniques, and endoscopy-related injury was sent to practicing gastroenterologists. Statistical analysis was performed on the data. The survey was answered by 107 gastroenterologists, 41 (38.3%) female subjects and 66 (61.7%) male subjects. Female participants were shorter in height, had smaller hand sizes, and performed fewer weekly cases. More men (45.5%) than women (20%) performed advanced endoscopic procedures. Women preferred the following: (1) holding the endoscope with the umbilical cord outside the forearm; (2) using the right hand to turn the small wheel; and (3) using a pediatric colonoscope to perform colonoscopy in a petite patient or one with a low body mass index. Endoscopy-related injury was reported in 49.5% of all gastroenterologists, with women reporting a significantly higher risk of injury (63.4%) than men (40.9%) (P= .02). Although higher weekly case volumes and performance of advanced endoscopy procedures were not independent risk factors for endoscopy-related injury, female gender was found to be an independent risk factor for injury. Gender differences exist in endoscopy styles and techniques, as well as endoscopy-related injury. Providing gender-specific training in endoscopy may improve ergonomics and decrease the risk of injury.

Innovative therapeutic strategies in the treatment of gastroesophageal reflux disease (GERD): A review of progress and perspectives.

Gastroesophageal Reflux Disease (GERD) is a commonly occurring condition that can significantly impact quality of life. Often considered a lifestyle disease. Traditional treatment methods focus on pharmacotherapy, lifestyle modifications, and in extreme cases, surgical interventions. This article discusses current and novel approaches to managing gastroesophageal reflux disease. The foundation of this work was medical articles and research gathered from the PubMed database. Keywords such as "esophageal reflux treatment", "new technologies in GERD treatment", "innovative reflux treatment methods", were used to facilitate the literature search. In managing gastroesophageal reflux disease, the application of appropriate pharmacological therapy and lifestyle changes for the patient remains key. However, new technologies and treatment methods, such as advanced endoscopic repair procedures, innovative medications, and personalized approaches, are gaining importance. These new strategies can significantly improve patients' quality of life, reduce symptoms, and minimize the need for surgical interventions.

The Role of Specialized Instruments for Advanced Endoscopic Resections in Gastrointestinal Disease.

Advanced endoscopic therapy techniques have been developed and have created alternative treatment options to surgical therapy for several gastrointestinal diseases. This work will focus on new endoscopic tools for special indications of advanced endoscopic resections (ER), especially endoscopic submucosal dissection (ESD), which were developed in our institution. This paper aims to analyze these specialized instruments and identify their status. Initially, the technical process of ESD was analyzed, and the following limitations of the different endoscopic steps and the necessary manipulations were determined: the problem of traction-countertraction, the grasping force needed to pull on tissue, the instrument tip maneuverability, the limited angulation/triangulation, and the mobility of the scope and instruments. Five instruments developed by our team were used: the Endo-dissector, additional working channel system, external independent next-to-the-scope grasper, 3D overtube working station, and over-the-scope grasper. The instruments were used and applied according to their special functions in dry lab, experimental in vivo, and clinical conditions by the members of our team. The Endo-dissector has a two-fold function: (1) grasping submucosal tissue with enough precision and strength to pull it off the surrounding mucosa and muscle, avoiding damage during energy application and (2) effectively dividing tissue using monopolar energy. The AWC system quickly fulfills the lack of a second working channel as needed to complete the endoscopic task on demand. The EINTS grasper can deliver a serious grasping force, which may be necessary for a traction-countertraction situation during endoscopic resection for lifting a larger specimen. The 3D overtube multifunctional platform provides surgical-like work with bimanual-operated instruments at the tip of the scope, which allows for a coordinated approach during lesion treatment. The OTSG is a grasping tool with very special features for cleaning cavities with debris. The research and development of instruments with special features can solve unmet needs in advanced endoscopic procedures. The latter may help to increase indications for the endoscopic resections of gut lesions in the future.

Can multiple-degree-of-freedom articulating instruments be effective in pediatric endoscopic surgery? - A prospective trial

BackgroundPediatric endosurgery often requires intracorporeal suturing, including reverse or vertical needle driving, which is difficult using a conventional instrument because of limited degrees of freedom (DOFs). To address this, multiple-DOF (mDOF) articulating instruments (mDOF-AIs) have been developed. We therefore evaluated the usefulness of mDOF-AIs compared with conventional instruments. MethodsARTISENTIALⓇ (LivsMed, Seongnum-si, Republic of Korea) was used as the mDOF-AI. Forty medical students were randomly divided into groups using conventional or mDOF articulating graspers to compare their proficiency with three-dimensional peg transfer. Task completion time and number of errors (dropping a peg) were evaluated. In addition, among pediatric surgeon participants, the number of practice times taken to reach the goal (completion of peg transfer within two minutes and vertical suturing) was measured. After achieving the goal, three vertical sutures of laparoscopic hepaticojejunostomy of the simulator were performed using the conventional and mDOF articulating needle-driver. The task completion time and quality of suturing were then evaluated. ResultsForty medical students were enrolled. The mDOF group showed significantly longer task completion times but significantly fewer errors than the conventional group (0.7 vs. 1.4 times, p = 0.03). Six pediatric surgeons achieved the goal in 42.5 min of practice on average. Using the mDOF articulating needle-driver, laparoscopic hepaticojejunostomy took significantly longer than with the conventional needle-driver (1120 vs. 856 s, p<0.01); however, the suturing quality improved significantly. ConclusionThe quality of basic and advanced endoscopic procedures using mDOF-AIs was higher than that with conventional instruments. mDOF-AIs potentially have safe and accurate performance.

Describing and Predicting Preprocedural Anxiety in Patients Scheduled for Advanced Gastrointestinal Endoscopy During the COVID-19 Pandemic.

Advanced gastrointestinal endoscopy includes a group of specialized procedures and interventions that are being performed more frequently, with little attention given to a patient's preprocedural anxiety issues. Compounding this concern, in 2020 the COVID-19 pandemic resulted in the delay of many endoscopy cases. It is unknown how this affected the anxiety of patients preparing for advanced endoscopy procedures. Patients with higher anxiety require higher doses of anesthetic medications, and experience increased pain and decreased satisfaction. The purpose of this study was to describe the biological, psychological, and social attributes of patients and identify whether social support, COVID-19-related anxiety, delay of procedure, patient's physical status, and procedural indication category were predictors of state anxiety levels in patients undergoing advanced gastrointestinal endoscopy during the COVID-19 pandemic. The research study was a cross-sectional descriptive design with 90 patients. Patients were classified into low state and high state anxiety groups. Fifty-eight percent of patients had high state anxiety scores. Using logistic regression, social support was identified as a predictor of preprocedural anxiety (odds ratio [OR] = 0.318 [95% confidence interval, CI = 0.170, 0.597, p < .001]) as less social support was associated with higher anxiety. It is imperative that strategies to maximize social support are reinforced.

Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection.

Up to 15% of colorectal polyps are amenable for conventional polypectomy. Advanced endoscopic resection techniques are introduced for the treatment of those polyps. They provide higher en bloc resection rates compared with conventional techniques, while helping patients to avoid the complications of surgery. Note that 20 mm is considered as the largest size of a polyp that can be resected by polypectomy or endoscopic mucosal resection (EMR) in an en bloc fashion. Endoscopic submucosal dissection (ESD) is recommended for polyps larger than 20 mm. Intramucosal carcinomas and carcinomas with limited submucosal invasion can also be resected with ESD. EMR is snare resection of a polyp following submucosal injection and elevation. ESD involves several steps such as marking, submucosal injection, incision, and dissection. Bleeding and perforation are the most common complications following advanced endoscopic procedures, which can be treated with coagulation and endoscopic clipping. En bloc resection rates range from 44.5 to 63% for EMR and from 87.9 to 96% for ESD. Recurrence rates following EMR and ESD are 7.4 to 17% and 0.9 to 2%, respectively. ESD is considered enough for the treatment of invasive carcinomas in the presence of submucosal invasion less than 1000 μm, absence of lymphovascular invasion, well-moderate histological differentiation, low-grade tumor budding, and negative resection margins.

Barriers to Implementation of Advanced Endoscopic Procedures.

Advanced endoscopy has been shown to be useful in the diagnosis and treatment of both benign and low-grade malignant colorectal lesions. In fact, advanced endoscopic procedures are being adopted as standard approaches to these lesions in many places around the world; however, their implementation in the United States has not been as widespread. We ascribe the difficulty in implementation to two reasons: (1) lack of advanced endoscopic training and (2) failure in reimbursement models as they relate to endoscopy. In this article, we hope to describe these barriers and inspire colorectal surgeons to try and overcome them. As surgical specialists with a mastery of endoscopic techniques, colorectal surgeons would be able to maximize benefit for their patients and minimize health care costs in the long run.

Quality of recovery and pre-existing impaired cognition in patients undergoing advanced GI endoscopic procedures with patient-controlled sedation: a prospective observational cohort study

Quality of recovery and pre-existing impaired cognition in patients undergoing advanced GI endoscopic procedures with patient-controlled sedation: a prospective observational cohort study

Deep sedation versus orotracheal intubation for endoscopic sleeve gastroplasty (ESG): preliminary experience.

Endoscopic sleeve gastroplasty (ESG) is an emerging bariatric procedure currently performed under general anaesthesia with orotracheal intubation (OTI). Several studies have shown the feasibility of advanced endoscopic procedures under deep sedation (DS) without impacting patient outcomes or adverse event rates. Our goal was to perform an initial comparative analysis of ESG in DS with ESG under OTI. A prospective institutional registry was reviewed for ESG patients between 12/2016 and 1/2021. Patients were stratified into OTI or DS cohorts, and the 1st 50 cases performed in each cohort were included for comparability. Univariate analysis was performed on demographics, intraoperative, and postoperative outcomes (up to 90days). Multivariate analyses evaluated the relationship between anesthesia type, preclinical and clinical variables. Of the 50DS patients, 21(42%) underwent primary and 29 (58%) revisional surgery. There was no significant differences in Mallampati score across groups. No DS patient required intubation. DS patients were younger (p = 0.006) and lower BMI (p = 0.002) than OTI. As expected, DS patients overall and in the primary subgroup had shorter operative time (p ≤ 0.001 and p = 0.003, respectively) and higher rates (84% DS vs. 20% OTI, p ≤ 0.001) of ambulatory procedures. There were no significant differences in the sutures used between groups (p = 0.616). DS patients required less postoperative opioids (p ≤ 0.001) and antiemetics (p = 0.006) than OTI. There were no significant differences in 3-month postoperative weight loss across cohorts. There was no rehospitalization in either group. In primary ESG cases, we found DS patients were more likely younger (p = 0.006), female (p = 0.001), and had a lower BMI (p = 0.0027). ESG under DS is safe and feasible in select patients. We found DS safely increased rates of outpatient care, reduced use of opioids and antiemetics, and provided the same results of postoperative weight loss. Patient selection for DS may be more clearer for durable weight loss.

WEO Newsletter.

WEO Newsletter.

Retrospective Analysis of Characteristics, Indications and Outcomes of Endoscopic Retrograde Cholangiopancreatography (ERCP) in a Tertiary Referral Center in Saudi Arabia.

Endoscopic retrograde cholangiopancreatography (ERCP) is an advanced endoscopic procedure that is an essential tool in the management of pancreaticobiliary diseases. There is limited data available on the indications and outcomes of ERCP from this region. Therefore, we aim to report the characteristics of patients, indications and outcomes of ERCP in Saudi Arabia. Methods: We retrospectively looked at ERCP procedures done at a tertiary referral center covering the western region of Saudi Arabia from August 2018 until July 2020. Data were collected from the hospital's electronic patient record and endoscopy database. Of 1001 ERCPs performed, full data was available on 712 procedures on 581 patients that were included in the final analysis. Mean age was 53.1 years. Four hundred four (56.7%) were female. Board-certified consultants performed all ERCPs. The most common intervention was sphincterotomy, which was performed in 563(96.9%) patients who underwent first-ever ERCP, followed by dilatation and stenting. The commonest indication of ERCP was confirmed or suspected choledocholithiasis (52.6%), followed by replacement or removal of a biliary stent (15.7%), 55 (7.7%) for suspected ascending cholangitis, 54 (7.5%) for acute biliary pancreatitis and 15 (2%) for suspected sphincter of Oddi dysfunction. The commonest finding among all patients was choledocholithiasis in 57.9%, debris in 15.2% and biliary stricture in 14.8%. The commonest complication was pancreatitis in 22(3.1%) followed by post-sphincterotomy bleeding in 16(2.2%) and perforation in nine (1.2%). Bleeding was controlled by endoscopic intervention in four (25%) and one (6.2%) patient underwent surgery. One (0.14%) patienthad procedure-related mortalitysecondary to post-procedure pulmonary embolism and one had significant morbidity and prolonged hospitalization because of complicated perforation. The deeper common bile duct (CBD) cannulation rate was 97.3%. Our study results revealed that ERCP performed in the western region of Saudi Arabia has similar indications and findings as reported in theinternational literature. ERCP is successful in achieving the therapeutic objectives with complication rates consistent with published data.

Medical disputes related to advanced endoscopic procedures with endoscopic retrograde cholangiopancreatography or endoscopic ultrasonography for the management of pancreas and biliary tract diseases.

This study aimed to evaluate the characteristics of endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic ultrasonography (EUS)-related adverse events (AEs) that eventually lead to medical disputes or claims on medical professional liability. Medical disputes for ERCP/EUS-related AEs filed in the Korea Medical Dispute Mediation and Arbitration Agency between April 2012 and August 2020 were evaluated using corresponding medical records. AEs were categorized into three sections: procedure-related, sedation-related, and safety-related AEs. Among a total of 34 cases, procedure-related AEs were 26 (76.5%; 12 duodenal perforations, 7 post-ERCP pancreatitis, 5 bleedings, 2 perforations combined with post-ERCP pancreatitis); sedation-related AEs were 5 (14.7%; 4 cardiac arrests, 1 desaturation), and safety-related AEs were 5 (8.8%; 1 follow-up loss for stent removal, 1 asphyxia, 1 fall). Regarding clinical outcomes, 20 (58.8%) were fatal and eventually succumbed to AEs. For the types of medical institutions, 21 cases (61.8%) occurred at tertiary or academic hospitals, and 13 (38.2%) occurred at community hospitals. The ERCP/EUS-related AEs filed in Korea Medical Dispute Mediation and Arbitration Agency showed distinct features: duodenal perforation was the most frequent AE, and clinical outcomes were fatal, resulting in at least more than permanent physical impairment.

A129 A RETROSPECTIVE ANALYSIS OF ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN PATIENTS WITH PANCREATICODUODENECTOMY

Abstract Background Surgically altered anatomy remains a challenge when performing advanced endoscopic procedures including endoscopic retrograde cholangiopancreatography (ERCP). Post-surgical anatomy frequently encountered in clinical practice that affects ERCP success includes Billroth II, roux-en-y gastric bypass, roux-en-y hepaticojejunostomy and pancreaticoduodenectomy (PD). While ERCP has a success rate of 90-95% in patients with native anatomy, the data is less robust in patients with PD anatomy. Advancement of the endoscope to the surgical anastomoses remains challenging as PD anatomy requires accurate identification of the afferent limb, and encourages acute bowel angulation and loop formation. In addition, navigation to the anastomosis may be more challenging with a sideviewing endoscope. Although forward viewing endoscopes may more readily reach the surgical anastomosis, cannulation may be difficult without an elevator or device-appropriate instruments. As a result, a retrospective analysis of technical and clinical success rates in ERCP was analyzed in post-PD patients. Purpose The purpose of this study was to evaluate the technical and clinical success of ERCP in patients with post-PD anatomy. Method A retrospective analysis was conducted on all patients with post-PD anatomy referred to our institution between 2006 to 2021 for ERCP. Demographic and procedural details including gender, age, indications, primary malignancy, and anastomosis identification were collected. Major outcomes included technical success (TS) rate (successful biliary or pancreatic intervention) and clinical success (CS) rate (improvement in patient symptomatology or normalization of bilirubin level). Result(s) A total of 47 patients underwent 102 ERCPs for biliary (n = 98; 96.1%) and pancreatic (n = 4; 3.9%) indications. There were 31 (66.0%) male patients and 16 (34.0%) female patients. The average age of patients was 61.5 years. The most common primary malignancies included pancreatic adenocarcinoma (n = 26; 55.3%), pancreatic neuroendocrine tumour (n = 5; 10.6%), and ampullary adenocarcinoma (n = 4; 8.5%). The most common indications for ERCP included obstructive jaundice (n = 22; 21.6%), stent evaluation (n = 30; 29.4%), and cholangitis (n = 35; 34.3%). Surgical anastomosis was identified in 90 (88.2%) patients. The overall TS and CS rates were 82.4% and 75.5%, respectively. When adjusted for anastomosis identification, the overall TS and CS rates were 93.3% and 82.2%. Conclusion(s) Despite the challenges of conducting ERCP in patients with post-PD anatomy, this retrospective analysis demonstrates an adequate overall TS and CS rate. Although endoscope advancement to the surgical anastomoses may be challenging, TS and CS rates improved if the anastomosis was reached and identified. The advent of endoscopic enteroenterostomy formation, balloon-assisted enterscopy, and rigidizing overtubes may assist in reaching surgical anastomoses. As a result, consideration should be undertaken to attempt ERCP in post-PD patients. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

The Learning Curve for Advanced Endoscopy for Colorectal Lesions: A Surgeon's Experience at a High-Volume Center.

Advanced endoscopy can be utilized for complete removal of large colorectal polyps. To date, few surgeons perform advanced endoscopy, and it is unknown how many procedures are needed to reach proficiency. To determine the learning curve for colorectal advanced endoscopy. Retrospective. Tertiary referral center. We queried a prospectively maintained institutional database of advanced endoscopy performed by a high-volume colorectal surgeon between 2011 and 2018. Advanced endoscopy characteristics were compared for 6 chronological intervals. Primary endpoints were the rates of complications and polyp recurrence. Secondary endpoint was the change in polyp removal rate (mm/hour) over time. Proficiency was defined as achieving low complication and polyp recurrence rates, high en-bloc resection rate, and an efficient removal rate, equivalent to the median polyp size per hour. Total of 207 patients underwent advanced endoscopy for a single colorectal polyp. Median polyp size was 30 (4-70) mm, 61.5% were located in right colon, and 8.8% were malignant. Mean procedure time was 77 (range, 16-320) minutes. Immediate colon resection occurred in 25 patients due to suspicion of cancer or concern for perforation and were excluded from learning curve analysis. The remaining 182 advanced endoscopy procedures were divided into intervals of 30 procedures. Median removal rate was highest in the last interval and in the endoscopy suite. A removal rate of 30 mm/hour was achieved after performing 100 cases. Complication rate (bleeding or return to OR) was 12.1% and was similar across intervals. Readmission rate was 11.5%, and 6.6% of 6-month follow-up colonoscopies showed polyp recurrence at the resection site. Retrospective design, single surgeon. The learning curve for achieving proficiency with advanced endoscopy in the colon and rectum requires a minimum of 100 cases with a low complication rate, low polyp recurrence rate, high en-bloc resection rate, and a polyp removal rate of 30mm/hr.

The Roth Net at 40 years: celebrating the spirit of innovation

The Roth Net at 40 years: celebrating the spirit of innovation

Etomidate versus propofol for sedation in gastrointestinal endoscopy: A systematic review and meta-analysis of outcomes.

Propofol is increasingly being used for sedation in gastrointestinal endoscopy; however, owing to its side effects, an alternative drug is needed. We aimed to compare the safety, satisfaction, and efficacy outcomes of etomidate versus propofol in patients undergoing gastrointestinal endoscopy, including advanced endoscopic procedures. We systematically searched Embase, PubMed, Cochrane Central Register of Controlled Trials, CINAHL (via EBSCO), China National Knowledge Infrastructure, and Web of Science (1946-April 2020) databases for randomized controlled trials of gastrointestinal endoscopy (upper gastrointestinal endoscopy, colonoscopy, and advanced endoscopy) using etomidate or propofol as sedatives. We pooled odds ratios (ORs) for the safety profile and patient and anesthesiologist satisfaction using mixed-effects conditional logistic models and standardized mean differences for efficiency outcomes using random-effects models. Twenty-four studies involving 3875 patients were included. Compared with propofol, etomidate resulted in significantly reduced apnea (OR: 0.22; 95% confidence interval [CI]: 0.13-0.37; P < .001), hypoxemia (OR: 0.43; 95% CI: 0.35-0.54; P < .001), hypotension (OR: 0.20; 95% CI: 0.11-0.36; P < .001), and bradycardia (OR: 0.52; 95% CI: 0.30-0.91; P = .02) but led to increased myoclonus (OR: 8.54; 95% CI: 5.20-14.01; P < .001) and lowered anesthesiologist satisfaction (OR: 0.60; 95% CI: 0.39-0.91; P = .02). Etomidate may be a good alternative to propofol for gastrointestinal endoscopy, especially advanced endoscopy. Etomidate appears to be safe as an inducer for hemodynamically unstable patients or older adult patients undergoing gastrointestinal endoscopy.

Do surface morphology and pit pattern have a role in predicting cancer for colon polyps in North America?

The surface morphology of colorectal polyps is well correlated with submucosal invasion in Eastern Countries but not in North America. We aimed to investigate associations between the Paris classification, surface morphology, and Kudo pit pattern to submucosal invasion in advanced endoscopic resection techniques. We retrospectively analyzed prospectively collected data of consecutive advanced endoscopic procedures conducted by a single surgeon between August 2017 and October 2018. The data included patients' demographics, the endoscopic finding of polyps (Paris, Kudo, and surface morphology), and pathology results. The study consisted of 138 lesions, and the mean age was 67 ± 10years. The most common polyp locations were cecum (n = 41, 30%) followed by ascending colon (n = 28, 20%), and sigmoid colon (n = 18, 13%).The median polyp size was 30mm (25-40). The en-bloc resection rate was 96%, and 11 (8%) polyps had adenocarcinoma with submucosal invasion. Nine patients (6.5%) had late bleeding, and 3 (2.2%) perforation occurred. Polyps with pit pattern of Kudo IV (n = 4, 36.4%) and Kudo V (n = 6, 54.5%) were associated with submucosal invasion. Surface morphology and pit pattern can predict submucosal invasion in the North American patient population. Polyp morphology may aid polyp selection for advanced endoscopic interventions.