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Lee, Shin, Park, Kim, Hong, Hong, Yang, Lee, Kim, Kim, Yang, Kim, Kim, Kim, and Multi-Society Task Force for Development of Guidelines for Colorectal Polyp Screening, Surveillance and Management: Korean Guidelines for Colonoscopic Polypectomy
Special Review
Korean Guidelines for the Diagnosis and Management of Colorectal Polyps
The Korean Journal of Gastroenterology

The Korean Journal of Gastroenterology 2012; 59(2): 85-98.

Published online: 23 February 2012

DOI: https://doi.org/10.4166/kjg.2012.59.2.85

Korean Guidelines for Colonoscopic Polypectomy

Suck-Ho Lee1, Sung Jae Shin2, Dong Il Park3, Seong-Eun Kim4, Sung Pil Hong5, Sung Noh Hong6, Dong-Hoon Yang7, Bo In Lee8, Young-Ho Kim3, Hyun-Soo Kim9, Suk-Kyun Yang7, Hyo Jong Kim10, Se Hyung Kim11, Hyun Jung Kim12; Multi-Society Task Force for Development of Guidelines for Colorectal Polyp Screening, Surveillance and Management

1Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea.

2Department of Internal Medicine, Ajou University School of Medicine, Suwon, Korea.

3Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea.

4Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea.

5Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

6Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.

7Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea.

8Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.

9Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.

10Department of Internal Medicine, Kyunghee University College of Medicine, Seoul, Korea.

11Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.

12Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea.

Correspondence to: Dong Il Park, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108 Pyung-dong, Jongro-gu, Seoul 110-746, Korea. Tel: +82-2-2001-2059, Fax: +82-2-2001-2048, diksmc.park@samsung.com

Copyright © 2012 The Korean Society of Gastroenterology

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

There are indirect evidences to suggest that 80% of colorectal cancers (CRC) develop from adenomatous polyps and that, on average, it takes 10 years for a small polyp to transform into invasive CRC. In multiple cohort studies, colonoscopic polypectomy has been shown to significantly reduce the expected incidence of CRC by 76% to 90%. Colonoscopic polypectomy is performed frequently in primary, secondary and tertiary and medical centers in Korea. However, there are no evidence-based, procedural guidelines for the appropriate performance of this procedure, including the technical aspects. For the guideline presented here, Pubmed, Medline, and Cochrane Library literature searches were performed. When little or no data from well-designed prospective trials were available, an emphasis was placed on the results from large series and reports from recognized experts. Thus, these guidelines for colonoscopic polypectomy are based on a critical review of the available data as well as expert consensus. Further controlled clinical studies are needed to clarify aspects of this statement, and revision may be necessary as new data become available. This guideline is intended to be an educational device to provide information that may assist endoscopists in providing care to patients. This guideline is not a rule and should not be construed as a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment. Clinical decisions for any particular case involve a complex analysis of the patient's condition and the available courses of action.

Keywords: Colonoscopy, Polypectomy, Guideline

Figures and Tables

Fig. 1
Efficacy of prophylactic saline with epinephrine injection prior to snare polypectomy for the prevention of overall bleeding (early and late).
kjg-59-85-g001
Fig. 2
Efficacy of prophylactic saline with epinephrine injection prior to snare polypectomy for the prevention of early bleeding.
kjg-59-85-g002
Fig. 3
Efficacy of prophylactic saline with epinephrine injection prior to snare polypectomy for the prevention of late bleeding.
kjg-59-85-g003
Fig. 4
Efficacy of the prophylactic method (endoloop or clip application) for the prevention of early bleeding in cases with large pedunculated polyps.
kjg-59-85-g004
Fig. 5
Efficacy of the prophylactic method (endoloop or clip application) for the prevention of delayed bleeding in cases with large pedunculated polyps.
kjg-59-85-g005
Fig. 6
Subgroup analysis of prophylactic methods vs. submucosal injections for the prevention of early bleeding.
kjg-59-85-g006
Fig. 7
Subgroup analysis of prophylactic methods vs. submucosal injections for the prevention of delayed bleeding.
kjg-59-85-g007
Fig. 8
Subgroup analysis of the prophylactic method vs. no injection for the prevention of early bleeding.
kjg-59-85-g008
Fig. 9
Subgroup analysis of the prophylactic method vs. no injection for the prevention of delayed bleeding.
kjg-59-85-g009
Fig. 10
Efficacy of the prophylactic method (argon plasma coagulation or clip application) for the prevention of delayed bleeding.
kjg-59-85-g010
Table 1
Quality of Evidence and the Strength of a Recommendation
kjg-59-85-i001
Table 2
Risk Stratification for Thromboembolism
kjg-59-85-i002
Table 3
Studies on Aspirin Use prior to Colon Polypectomy
kjg-59-85-i003

Values are presented as n (%).

NA, not assessed.

Table 4
Residual Rate after the Removal of Diminutive Polyps
kjg-59-85-i004

Values are presented as n (%).

EMR, endoscopic mucosal resection; NA, not assessed.

Table 5
Complication Rates after the Removal of Diminutive Polyps
kjg-59-85-i005

NA, not assessed.

Table 6
Studies of Malignant Polyp Invading the Submucosa in Surgically Resected Colorectal Specimens
kjg-59-85-i006

LN, lymph node; WD, well-differentiated; MD, moderate-differentiated; PD, poorly-differentiated; NA, non-assessed.

Notes

Financial support: This study was initiated with the support of the Korean Society of Gastroenterology, the Korean Society of Gastrointestinal Endoscopy, and the Korean Association for the Study of Intestinal Diseases. This study was supported by a grant for the Korean Health Technology R&D Project with the Ministry for Health, Welfare & Family Affairs of the Republic of Korea (A102065-23).

Conflict of interest: None.

These guildelines are being co-published in the Korean Journal of Gastroenterolgy, the Intestinal Research, the Clinical Endoscopy, and the Journal of the Korean Society of Radiology for the faciliated distribution.

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ORCID iDs

Dong Il Park
https://orcid.org/http://orcid.org/0000-0003-2307-8575

Dong-Hoon Yang
https://orcid.org/http://orcid.org/0000-0001-7756-2704

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