Unresolved aspects of the search and removal of flat epithelial lesions of the colon

A significant part of epithelial neoplasia of the colon are the so-called flat neoplasms (lesions 0-IIa and 0-IIb according to the Paris endoscopic classification of superficial neoplastic lesions), which are sometimes called invisible due to the difficulty of detecting such lesions during screening colonoscopies. It has been proven that the removal of epithelial lesions of the colon during colonoscopy can significantly reduce mortality from colorectal cancer. In recent years, simpler and safer methods of endoscopic polypectomy have been used in everyday clinical practice to remove flat neoplasms. Of these methods, the most widely used worldwide is cold loop polypectomy, in which epithelial formations are cut off mechanically with a polypectomy loop without applying current. Cold loop polypectomy can also be performed on an outpatient basis, thereby preventing colorectal cancer directly during the initial examination. This method is safe and does not lead to undesirable complications. However, despite the simplicity of the method, there are several unresolved aspects of finding and removing flat epithelial formations of the colon: a detailed description of the localization of flat neoplasms for subsequent removal and control colonoscopies, incomplete cutting and getting stuck of the cold polypectomy loop in the polyp tissue when removing flat epithelial neoplasms larger than 8 mm, extraction of removed epithelial formations for histological examination, which are discussed and resolved in this article.