WHAT IMPROVED AND WHAT REMAINS TO BE ACHIEVED IN ORDER TO COMPLY WITH THE NEW RECOMMENDATIONS OF POLYPECTOMY BY THE EUROPEAN SOCIETY OF GASTROINTESTINAL ENDOSCOPY

 

Aims:

Recently, the European Society of Gastrointestinal Endoscopy (ESGE) published recommendations for colorectal polypectomy and endoscopic mucosal resection (EMR). We aimed to evaluate the recent years evolution of the adherence to these recommendations at a tertiary center.

Methods:

Unicentric analysis of polypectomy and EMR techniques performed consecutively between January and June of 2011 and 2016 at a tertiary center. According to the recommendations, excision of sessile and flat polyps was considered adequate when performed with cold biopsy forceps or cold snare for polyps ≤3 mm, cold snare if 4 – 9 mm, cold or hot snare if 10 – 19 mm and EMR if ≥20 mm. Polypectomy of pedunculated polyps was considered adequate when performed with a diathermic loop in polyps < 20 mm, in association with prophylactic therapy when polyp size ≥20 mm.

Results:

We included 1721 endoscopic procedures concerning 696 patients (64.5% male; mean age = 64.2 ± 11.0 years). Regarding sessile and flat polyps, one of the recommended excision techniques was performed in: 84.6% (n = 270) of ≤3 mm polyps (75.7% in 2011 Vs. 95.8% in 2016; p < 0.001); 22.2% (n = 109) of 4 – 5 mm polyps (12.5% Vs. 36.5%; p < 0.001); 13.4% (n = 59) of 6 – 9 mm polyps (5.4% Vs. 23.8%; p < 0.001); 100% (n = 206) of 10 – 19 mm polyps; and 100% (n = 88) of ≥20 mm lesions. For pedunculated polyps, the resection technique was adequate in: 99.3% (n = 134) of polyps of size < 20 mm (100% Vs. 97.6%; p > 0.05) and in 84.6% (n = 44) of those ≥20 mm (82.6% Vs. 86.2%; p > 0.05). Overall, 52.3% (n = 900) of endoscopic procedures were performed as recommended; 42.7% (n = 410) in 2011 vs. 64.5% (n = 490) in 2016; p < 0.001.

Conclusions:

Even before publication of the recommendations there has already been an increase in the proportion of adequate polypectomies. There is still a need to adjust clinical practice in some subgroups, especially in 4 – 9 mm polyps, in order to strictly comply with the recommendations.