ESGE recommended polyp resection technique

  Colonoscopy

ESGE recommended polyp resection technique

Resection Techniques According to Polyp Shape and Size

  1. Diminutive Polyps (≤ 5 mm)
    • Preferred Technique: Cold Snare Polypectomy (CSP).
    • Alternative: Cold biopsy forceps can be considered for polyps ≤ 3 mm where CSP is technically difficult.
  2. Small Polyps (6-9 mm)
    • Preferred Technique: Cold Snare Polypectomy (CSP) to achieve en bloc resection.
  3. Intermediate Polyps (10-19 mm)
    • Preferred Technique: Hot Snare Polypectomy (HSP).
    • Additional Considerations:
      • Submucosal injection prior to HSP should be considered to reduce the risk of deep thermal injury.
  4. Large Polyps (≥ 20 mm)
    • Preferred Technique: En bloc Endoscopic Mucosal Resection (EMR) to achieve R0 resection.
    • When En Bloc Resection is Not Feasible: Piecemeal EMR is recommended.
    • Referral Consideration: If the lesion is > 40 mm or complex, refer to an expert center.
  5. Suspected Superficial Submucosal Invasion
    • Recommended Action:
      • Tattoo 3 cm distal to the lesion.
      • Refer to an expert center for en bloc EMR, Endoscopic Submucosal Dissection (ESD), or surgery.
  6. Suspected Deep Submucosal Invasion
    • Recommended Action:
      • Tattoo 3 cm distal to the lesion.
      • Refer for surgical resection.
  7. Pedunculated Polyps
    • Head Size < 20 mm and Stalk Width < 10 mm: Hot Snare Polypectomy.
    • Head Size ≥ 20 mm or Stalk Width ≥ 10 mm:
      • Injection with 1:10,000 adrenaline and/or prophylactic mechanical hemostasis followed by Hot Snare Polypectomy.

https://www.esge.com/assets/downloads/pdfs/guidelines/2017_s_0043_102569.pdf