Endoscopy 2024; 56(07): 516-545
DOI: 10.1055/a-2304-3219
Guideline

Colorectal polypectomy and endoscopic mucosal resection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2024

Monika Ferlitsch
 1   Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
 2   Department of Gastroenterology, Evangelical Hospital, Vienna, Austria
,
Cesare Hassan
 3   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
 4   Endoscopy Unit, Humanitas Clinical and Research Center – IRCCS, Rozzano, Italy
,
Raf Bisschops 
 5   Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, KU Leuven, Leuven, Belgium
,
Pradeep Bhandari
 6   Endoscopy Department, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
,
Mário Dinis-Ribeiro
 7   Department of Gastroenterology, Portuguese Oncology Institute of Porto, Porto, Portugal
 8   MEDCIDS/Faculty of Medicine, University of Porto, Porto, Portugal
 9   Porto Comprehensive Cancer Center (Porto.CCC) and RISE@CI-IPOP (Health Research Network), Porto, Portugal
,
Mauro Risio
10   Department of Pathology, Institute for Cancer Research and Treatment, Candiolo, Turin, Italy
,
Gregorios A. Paspatis
11   Gastroenterology Department, Venizeleio General Hospital, Heraklion, Crete, Greece
,
Alan Moss
12   Department of Gastroenterology, Western Health, Melbourne, Australia
13   Department of Medicine, Western Health, Melbourne Medical School, University of Melbourne, Melbourne, Australia
,
Diogo Libânio 
 7   Department of Gastroenterology, Portuguese Oncology Institute of Porto, Porto, Portugal
 8   MEDCIDS/Faculty of Medicine, University of Porto, Porto, Portugal
 9   Porto Comprehensive Cancer Center (Porto.CCC) and RISE@CI-IPOP (Health Research Network), Porto, Portugal
,
Vincente Lorenzo-Zúñiga 
14   Endoscopy Unit, La Fe University and Polytechnic Hospital / IISLaFe, Valencia, Spain
15   Department of Medicine, Catholic University of Valencia, Valencia, Spain
,
Andrei M. Voiosu 
16   Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
17   Internal Medicine and Gastroenterology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
,
Matthew D. Rutter 
18   Department of Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK
19   Department of Gastroenterology, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
,
Maria Pellisé 
20   Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
21   Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
,
Leon M. G. Moons
22   III Medizinische Klinik, Universitätsklinikum Augsburg, Augsburg, Germany
,
Andreas Probst
23   Department of Gastroenterology, University Hospital of Augsburg, Augsburg, Germany
,
Halim Awadie 
24   Ellen and Pinchas Mamber Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula, Israel
,
Arnaldo Amato 
25   Digestive Endoscopy and Gastroenterology Department, Ospedale A. Manzoni, Lecco, Italy
,
Yoji Takeuchi 
26   Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Gunma, Japan
,
Alessandro Repici
 3   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
 4   Endoscopy Unit, Humanitas Clinical and Research Center – IRCCS, Rozzano, Italy
,
Gabriel Rahmi
27   Hepatogastroenterology and Endoscopy Department, Hôpital européen Georges Pompidou, Paris, France
28   Laboratoire de Recherches Biochirurgicales, APHP-Centre Université de Paris, Paris, France
,
Hugo U. Koecklin 
29   Hospital Universitari Germans Trias i Pujol, Badalona, Spain
30   Teknon Medical Center, Barcelona, Spain
,
Eduardo Albéniz 
31   Gastroenterology Department, Hospital Universitario de Navarra (HUN); Navarrabiomed, Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
,
Lisa-Maria Rockenbauer
 1   Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
,
Elisabeth Waldmann
 1   Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
,
Helmut Messmann
22   III Medizinische Klinik, Universitätsklinikum Augsburg, Augsburg, Germany
,
Konstantinos Triantafyllou 
32   Hepatogastroenterology Unit, Second Department of Propaedeutic Internal Medicine, Medical School, National and Kapodastrian University of Athens, Attikon University General Hospital, Athens, Greece
,
Rodrigo Jover
33   Servicio de Medicina Digestiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria ISABIAL, Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain
,
Ian M. Gralnek
24   Ellen and Pinchas Mamber Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula, Israel
34   Rappaport Faculty of Medicine Technion Israel Institute of Technology, Haifa, Israel
,
Evelien Dekker 
35   Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
,
Michael J. Bourke
36   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
37   University of Sydney, Sydney, Australia
› Author Affiliations
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Main Recommendations

1 ESGE recommends cold snare polypectomy (CSP), to include a clear margin of normal tissue (1–2 mm) surrounding the polyp, for the removal of diminutive polyps (≤ 5 mm).

Strong recommendation, high quality of evidence.

2 ESGE recommends against the use of cold biopsy forceps excision because of its high rate of incomplete resection.

Strong recommendation, moderate quality of evidence.

3 ESGE recommends CSP, to include a clear margin of normal tissue (1–2 mm) surrounding the polyp, for the removal of small polyps (6–9 mm).

Strong recommendation, high quality of evidence.

4 ESGE recommends hot snare polypectomy for the removal of nonpedunculated adenomatous polyps of 10–19 mm in size.

Strong recommendation, high quality of evidence.

5 ESGE recommends conventional (diathermy-based) endoscopic mucosal resection (EMR) for large (≥ 20 mm) nonpedunculated adenomatous polyps (LNPCPs).

Strong recommendation, high quality of evidence.

6 ESGE suggests that underwater EMR can be considered an alternative to conventional hot EMR for the treatment of adenomatous LNPCPs.

Weak recommendation, moderate quality of evidence.

7 Endoscopic submucosal dissection (ESD) may also be suggested as an alternative for removal of LNPCPs of ≥ 20 mm in selected cases and in high-volume centers.

Weak recommendation, low quality evidence.

8 ESGE recommends that, after piecemeal EMR of LNPCPs by hot snare, the resection margins should be treated by thermal ablation using snare-tip soft coagulation to prevent adenoma recurrence.

Strong recommendation, high quality of evidence.

9 ESGE recommends (piecemeal) cold snare polypectomy or cold EMR for SSLs of all sizes without suspected dysplasia.

Strong recommendation, moderate quality of evidence.

10 ESGE recommends prophylactic endoscopic clip closure of the mucosal defect after EMR of LNPCPs in the right colon to reduce to reduce the risk of delayed bleeding.

Strong recommendation, high quality of evidence.

11 ESGE recommends that en bloc resection techniques, such as en bloc EMR, ESD, endoscopic intermuscular dissection, endoscopic full-thickness resection, or surgery should be the techniques of choice in cases with suspected superficial invasive carcinoma, which otherwise cannot be removed en bloc by standard polypectomy or EMR.

Strong recommendation, moderate quality of evidence.

Supplementary Material



Publication History

Article published online:
26 April 2024

© 2024. European Society of Gastrointestinal Endoscopy. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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