title: Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline.
abstract: 1ESGE 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.)2ESGE 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.)3ESGE 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.)4ESGE 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.)5ESGE 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.)6ESGE 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.)7For 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).
authors.affiliation: Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Austria.|Quality Assurance Working Group of the Austrian Society of Gastroenterology and Hepatology.
authors.forename: Monika
authors.initials: M
authors.lastname: Ferlitsch
authors.affiliation: Department of Endoscopic Services, Western Health, Melbourne, Australia.|Department of Medicine, Melbourne Medical School Western Precinct, The University of Melbourne, St. Albans, Victoria, Australia.
authors.forename: Alan
authors.initials: A
authors.lastname: Moss
authors.affiliation: Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy.
authors.forename: Cesare
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authors.affiliation: Solent Centre for Digestive Diseases, Queen Alexandra Hospital, Portsmouth, UK.
authors.forename: Pradeep
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authors.affiliation: Gedyt Endoscopy Center, Buenos Aires, Argentina.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Dumonceau
authors.affiliation: Department of Gastroenterology, Benizelion General Hospital, Heraklion, Crete, Greece.
authors.forename: Gregorios
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authors.lastname: Paspatis
authors.affiliation: Unidad de Gastroenterología, Servicio de Medicina Digestiva, Instituto de Investigación Sanitaria ISABIAL, Hospital General Universitario de Alicante, Alicante, Spain.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Jover
authors.affiliation: Department of Pathology, Medical University of Graz, Graz, Austria.
authors.forename: Cord
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authors.affiliation: Department of Gastroenterology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Maxime
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authors.affiliation: Department of Endoscopic Services, Western Health, Melbourne, Australia.|Department of Medicine, Melbourne Medical School Western Precinct, The University of Melbourne, St. Albans, Victoria, Australia.
authors.forename: Kumanan
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authors.lastname: Nalankilli
authors.affiliation: Department of Gastroenterology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Paul
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authors.affiliation: Institute of Gastroenterology and Hepatology, Ha'Emek Medical Center, Afula, Israel and Rappaport Family Faculty of Medicine Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Rawi
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authors.affiliation: Institute of Gastroenterology and Hepatology, Ha'Emek Medical Center, Afula, Israel and Rappaport Family Faculty of Medicine Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Ian M
authors.initials: IM
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authors.affiliation: Quality Assurance Working Group of the Austrian Society of Gastroenterology and Hepatology.
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authors.affiliation: Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Austria.|Quality Assurance Working Group of the Austrian Society of Gastroenterology and Hepatology.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Waldmann
authors.affiliation: Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Austria.|Quality Assurance Working Group of the Austrian Society of Gastroenterology and Hepatology.
authors.forename: Philip
authors.initials: P
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authors.affiliation: Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Austria.|Quality Assurance Working Group of the Austrian Society of Gastroenterology and Hepatology.
authors.forename: Daniela
authors.initials: D
authors.lastname: Penz
authors.affiliation: Department of Digestive Endoscopy, University Hospital, CHU Fort de France, France.
authors.forename: Denis
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authors.lastname: Heresbach
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Leon
authors.initials: L
authors.lastname: Moons
authors.affiliation: Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium.
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authors.lastname: Lemmers
authors.affiliation: Konstantopoulio General Hospital, Athens, Greece.
authors.forename: Konstantina
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authors.lastname: Paraskeva
authors.affiliation: Department of Gastroenterology, Asklepios Klinik Altona, Hamburg, Germany.
authors.forename: Juergen
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authors.affiliation: Department of Endoscopy and Gastroenterology, Edouard Herriot Hospital, Lyon, France.
authors.forename: Thierry
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authors.affiliation: Department of Gastroenterology, Maria Sklodowska-Curie Memorial CancerCenter and Medical Centre for Postgraduate Education, Warsaw, Poland.
authors.forename: Jaroslaw
authors.initials: J
authors.lastname: Regula
authors.affiliation: Humanitas Research Hospital, Humanitas University, Rozzano, Milan, Italy.
authors.forename: Alessandro
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authors.affiliation: School of Medicine, Pharmacy and Health, Durham University, Durham, UK.
authors.forename: Matthew D
authors.initials: MD
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authors.affiliation: Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia.|University of Sydney, Sydney, Australia.
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Burgess
authors.affiliation: Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia.|University of Sydney, Sydney, Australia.
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mesh_terms: D018256:Adenomatous Polyps / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D000465:Algorithms; D003106:Colon / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D003113:Colonoscopy / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D000069916:Endoscopic Mucosal Resection / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D006801:Humans; D007417:Intestinal Polyps / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D012007:Rectum / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*