ESGE recommended polyp resection technique
Resection Techniques According to Polyp Shape and Size
- 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.
- Small Polyps (6-9 mm)
- Preferred Technique: Cold Snare Polypectomy (CSP) to achieve en bloc resection.
- 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.
- 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.
- 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.
- Recommended Action:
- Suspected Deep Submucosal Invasion
- Recommended Action:
- Tattoo 3 cm distal to the lesion.
- Refer for surgical resection.
- Recommended Action:
- 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