Task Force Releases Recommendations for Endoscopic Removal of Colorectal Lesions

The US Multi-Society Task Force on Colorectal Cancer has released a consensus statement that includes recommendations for the optimization of complete and safe endoscopic removal techniques for colorectal lesions.

“There is clear evidence that endoscopic resection skills are quite variable, with a substantial need to increase the adoption of proven effective endoscopic resection techniques,” the authors wrote. “Intensive investigation of resection technique in the past 2 decades has made evidenced-based recommendations possible.”

The authors developed 6 overarching statements to provide guidance on lesion assessment and description, lesion removal, lesion marking, surveillance, equipment, and quality of polypectomy. Each statement is accompanied by a list of recommendations.

Among the strong recommendations that the Task Force made are the following:

• In the colonoscopy procedure report, document endoscopic descriptors of the lesion, including location, size in millimeters, and morphology.
• Perform cold snare polypectomy to remove diminutive (≤5 mm) and small (6-9 mm) lesions due to high complete resection rates and safety profile.
• Demarcate any lesion that may require localization at future endoscopic or surgical procedures with a tattoo, using sterile carbon particle suspension.
• Create an intensive follow-up schedule for patients after piecemeal endoscopic mucosal resection (EMR) (lesions ≥20 mm), with the first surveillance colonoscopy at 6 months and the intervals to the next colonoscopy at 1 year and 3 years.
• If an endoscopist encounters a suspected benign colorectal lesion that he or she is not confident to remove completely, he or she should recommend referral to an endoscopist experienced in advanced polypectomy for subsequent evaluation and management rather than referral for surgery.

“Colonoscopy with polypectomy reduces the incidence of and mortality from colorectal cancer,” the authors wrote. “It is the cornerstone of effective prevention.”

—Colleen Murphy

Reference:

Kaltenbach T, Anderson JC, Burke CA, et al. Endoscopic removal of colorectal lesions—recommendations by the US Multi-Society Task Force on Colorectal Cancer [published online February 11, 2020]. Gastroenterology. doi:10.1053/j.gastro.2019.12.018.