Endoscopy 2017; 49(03): 270-297
DOI: 10.1055/s-0043-102569
Guideline
© Georg Thieme Verlag KG Stuttgart · New York

Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline

Monika Ferlitsch
1   Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Austria
2   Quality Assurance Working Group of the Austrian Society of Gastroenterology and Hepatology
,
Alan Moss
3   Department of Endoscopic Services, Western Health, Melbourne, Australia
4   Department of Medicine, Melbourne Medical School Western Precinct, The University of Melbourne, St. Albans, Victoria, Australia
,
Cesare Hassan
5   Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
,
Pradeep Bhandari
6   Solent Centre for Digestive Diseases, Queen Alexandra Hospital, Portsmouth, UK
,
Jean-Marc Dumonceau
7   Gedyt Endoscopy Center, Buenos Aires, Argentina
,
Gregorios Paspatis
8   Department of Gastroenterology, Benizelion General Hospital, Heraklion, Crete, Greece
,
Rodrigo Jover
9   Unidad de Gastroenterología, Servicio de Medicina Digestiva, Instituto de Investigación Sanitaria ISABIAL, Hospital General Universitario de Alicante, Alicante, Spain
,
Cord Langner
10   Department of Pathology, Medical University of Graz, Graz, Austria
,
Maxime Bronzwaer
11   Department of Gastroenterology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
,
Kumanan Nalankilli
3   Department of Endoscopic Services, Western Health, Melbourne, Australia
4   Department of Medicine, Melbourne Medical School Western Precinct, The University of Melbourne, St. Albans, Victoria, Australia
,
Paul Fockens
11   Department of Gastroenterology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
,
Rawi Hazzan
12   Institute of Gastroenterology and Hepatology, Ha’Emek Medical Center, Afula, Israel and Rappaport Family Faculty of Medicine Technion-Israel Institute of Technology, Haifa, Israel
,
Ian M. Gralnek
12   Institute of Gastroenterology and Hepatology, Ha’Emek Medical Center, Afula, Israel and Rappaport Family Faculty of Medicine Technion-Israel Institute of Technology, Haifa, Israel
,
Michael Gschwantler
2   Quality Assurance Working Group of the Austrian Society of Gastroenterology and Hepatology
,
Elisabeth Waldmann
1   Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Austria
2   Quality Assurance Working Group of the Austrian Society of Gastroenterology and Hepatology
,
Philip Jeschek
1   Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Austria
2   Quality Assurance Working Group of the Austrian Society of Gastroenterology and Hepatology
,
Daniela Penz
1   Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Austria
2   Quality Assurance Working Group of the Austrian Society of Gastroenterology and Hepatology
,
Denis Heresbach
13   Department of Digestive Endoscopy, University Hospital, CHU Fort de France, France
,
Leon Moons
14   Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, Netherlands
,
Arnaud Lemmers
15   Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
,
Konstantina Paraskeva
16   Konstantopoulio General Hospital, Athens, Greece
,
Juergen Pohl
17   Department of Gastroenterology, Asklepios Klinik Altona, Hamburg, Germany
,
Thierry Ponchon
18   Department of Endoscopy and Gastroenterology, Edouard Herriot Hospital, Lyon, France
,
Jaroslaw Regula
19   Department of Gastroenterology, Maria Sklodowska-Curie Memorial Cancer
Center and Medical Centre for Postgraduate Education, Warsaw, Poland
,
Alessandro Repici
20   Humanitas Research Hospital, Humanitas University, Rozzano, Milan, Italy
,
Matthew D. Rutter
21   School of Medicine, Pharmacy and Health, Durham University, Durham, UK
,
Nicholas G. Burgess
22   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
23   University of Sydney, Sydney, Australia
,
Michael J. Bourke
22   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
23   University of Sydney, Sydney, Australia
› Author Affiliations
Further Information

Publication History

Publication Date:
17 February 2017 (online)

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Main recommendations

1 ESGE recommends cold snare polypectomy (CSP) as the preferred technique for removal of diminutive polyps (size ≤ 5 mm). This technique has high rates of complete resection, adequate tissue sampling for histology, and low complication rates. (High quality evidence, strong recommendation.)

2 ESGE suggests CSP for sessile polyps 6 – 9 mm in size because of its superior safety profile, although evidence comparing efficacy with hot snare polypectomy (HSP) is lacking. (Moderate quality evidence, weak recommendation.)

3 ESGE suggests HSP (with or without submucosal injection) for removal of sessile polyps 10 – 19 mm in size. In most cases deep thermal injury is a potential risk and thus submucosal injection prior to HSP should be considered. (Low quality evidence, strong recommendation.)

4 ESGE recommends HSP for pedunculated polyps. To prevent bleeding in pedunculated colorectal polyps with head ≥ 20 mm or a stalk ≥ 10 mm in diameter, ESGE recommends pretreatment of the stalk with injection of dilute adrenaline and/or mechanical hemostasis. (Moderate quality evidence, strong recommendation.)

5 ESGE recommends that the goals of endoscopic mucosal resection (EMR) are to achieve a completely snare-resected lesion in the safest minimum number of pieces, with adequate margins and without need for adjunctive ablative techniques. (Low quality evidence; strong recommendation.)

6 ESGE recommends careful lesion assessment prior to EMR to identify features suggestive of poor outcome. Features associated with incomplete resection or recurrence include lesion size > 40 mm, ileocecal valve location, prior failed attempts at resection, and size, morphology, site, and access (SMSA) level 4. (Moderate quality evidence; strong recommendation.)

7 For intraprocedural bleeding, ESGE recommends endoscopic coagulation (snare-tip soft coagulation or coagulating forceps) or mechanical therapy, with or without the combined use of dilute adrenaline injection. (Low quality evidence, strong recommendation.)

An algorithm of polypectomy recommendations according to shape and size of polyps is given ([Fig. 1]).

Appendix e1, e2