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The primary aim of polypectomy is complete removal of the colorectal lesion, and the subsequent prevention of colorectal cancer. Overall, the vast majority of benign colorectal lesions can be safely and effectively removed using endoscopic removal techniques. When an endoscopist encounters a suspected benign colorectal polyp that he/she is not confident to completely remove, MSTF recommends referral to an endoscopist experienced in advanced polypectomy for subsequent evaluation and management in lieu of referral for surgery.
Patient has diminutive (? 5mm) and small (6-9mm) polyp(s): Recommend cold snare polypectomy
Patient has non-pedunculated (? 20mm) polyp(s): Recommend endoscopic mucosal resection; Recommend snare resection of all grossly visible tissue of a polyp in a single colonoscopy session and in the safest minimum number of pieces; Recommend against the use of ablative techniques on endoscopically visible residual tissue of a polyp; Recommend the use of adjuvant thermal ablation of the post-EMR margin where no endoscopically visible adenoma remains despite meticulous inspection
Patient has pedunculated polyp(s): Recommend prophylactic mechanical ligation of the stalk with a detachable loop or clips on pedunculated polyps with head ?20mm or with stalk thickness ?5mm to reduce immediate and delayed post-polypectomy bleeding
Best practices for surveillance
MSTF recommends intensive follow-up schedule in patients following piecemeal endoscopic mucosal resection (lesions ? 20 mm) with the first surveillance colonoscopy at 6 months, and the intervals to the next colonoscopy at 1 year, and then 3 years.
About the American College of Gastroenterology
Founded in 1932, the American College of Gastroenterology (ACG) is an organization with an international membership of more than 14,000 individuals from 85 countries. The ACG will be the preeminent champion for prevention, diagnosis and treatment of digestive disorders by facilitating the highest quality, compassionate and evidence-based patient care.
About the AGA Institute
The American Gastroenterological Association is the trusted voice of the GI community. Founded in 1897, the AGA has grown to more than 16,000 members from around the globe who are involved in all aspects of the science, practice and advancement of gastroenterology. The AGA Institute administers the practice, research and educational programs of the organization.
