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

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.
Competing Interests: R. Bisschops has been on the advisory boards of Pentax, Medtronic, Fujifilm, Cook, Boston Scientific, and Olympus, and has received speaker’s fees from Pentax, Medtronic, and Fujifilm; his department has received research grants, and organizational support for events from Pentax and Medtronic, and further organizational support for events from Erbe, Ovesco, and Olympus (all within the last 3 years). M.J. Bourke has received research support from Cook Medical and Olympus (2014 to date). E. Dekker has provided consultancy to Olympus and GI supply (several occasions in recent years). M. Dinis-Ribeiro has provided consultancy to Medtronic and Roche (2021 to 2022) and received a research grant from Fujifilm (2021 to 2022). H. Messmann has provided consultancy to Ambu, Boston Scientific, and Olympus (2022 to date); his department has received research support from Olympus and Satisfai (2022 to date). L. Moons has provided consultancy to Boston Scientific and Pentax (2024 to date) and is a member of the Colorectal cancer guideline committee and chair of the Dutch Guideline group on polypectomy in the rectum and colon. M. Pellisé has provided consultancy to Norgine Iberia (2015 to 2019), GI supply (2019), Fujifilm Europe (2021 to date), and Olympus (2022 to date), and received research support from Fujifilm Spain (2019), Fujifilm Europe (2020 to 2021), Casen recordati (2020), and ZuiZ (2021); her department has also received equipment on loan from Fujifilm Europe (2019 to date); she was on the Endoscopy editorial board (2015 to 2021), was ESGE Equity and diversity working group chair (2021 to 2022), councillor for SEED (2016 to 2022), and is president of AEG (2022 to date). G. Rahmi has provided consultancy to Fujifilm and Medtronic (2023 to date). A. Repici has received consultancy fees and research funding from ERBE (2020 to date) and Fujifilm (2018 to date), and speaker’s and consultancy fees, and research funding from Boston Scientific (2019 to date). M. Rutter is a member of the British Society of Gastroenterology and is the current Chair of the Joint Advisory Group for Gastrointestinal Endoscopy. Y. Takeuchi has provided consultancy to Boston Scientific Japan (2012 to 2022) and has received speaker’s fees from Olympus, Daiichi-Sankyo, Miyarisan Pharmaceutical, Asuka Pharmaceutical, AstraZeneca, EA Pharma, Zeria Pharmaceutical, Fujifilm, Kaneka Medix, Kyorin Pharmaceutical, and the Japan Gastroenterological Endoscopy Society. H. Uchima Koecklin has received proctorship and speaker’s fees from ERBE Spain and Olympus Iberia (2022 to 2023). E. Albeniz, A. Amato, H. Awadie, P. Bhandari, M. Ferlitsch, I. Gralnek, C. Hassan R. Jover, D. Libanio, V. Lorenzo-Zuniga, A. Moss, G. Paspatis, A. Probst, M. Risio, L.-M. Rockenbauer, K. Triantafyllou, A. Voiosu, and E. Waldmann declare that they have no conflict of interest.
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