This study aimed to assess the current practice in our institution in terms of polypectomy technique across all polyp sizes and histological subtypes in comparison to the ESGE standards. 

A single centre, retrospective analysis of 100 consecutive patients who have had polypectomies done for polyps of any size from April 2024 at a hospital in North London was undertaken. The data was collected using the Medilogic endoscopy reporting tool, and the electronic patients record. The technique used for polypectomy, along with the type of polyp at histology retrieved, was scrutinized and compared with compliance of ESGE guidance on polypectomy technique. 

A total of 177 polypectomies from 100 patients were analysed. 101 polypectomies (57%) followed ESGE recommendations and 76 polypectomies (43%) did not. The 76 non-compliant polypectomies used methods including cold biopsy, hot snare for polyps under 10mm, hot EMR for polyps under 20mm and hot EMR for SSLs (Table 1).

The polypectomy technique used by endoscopists depends on multiple factors including anticipated histological subtype (eg Paris and Kudo pitt pattern), estimated polyp size and location within the colon. The latest European Society of Gastrointestinal Endoscopy (ESGE) guidelines recommend the most suitable methods which minimise risk of post-procedural bleeding and perforation, whilst ensuring cost-effectiveness. ESGE recommends avoiding cold biopsy due to its high rate of incomplete resection. ESGE also recommends cold snare polypectomy for removal of nonpedunculated adenomatous polyps under 10mm and hot snare with or without endoscopic mucosal resection (EMR) for polyps over 10mm. In addition, ESGE recommends cold snare or cold EMR for sessile serrated lesions (SSL) of all sizes, as well as consideration of endoscopic submucosal dissection (ESD) for certain polyps over 20mm.

This study shows poor adherence to the ESGE guidelines in our department with regards to colorectal polypectomies, with only two-thirds of polypectomies adhering to the recommended techniques. A third of polypectomies undertaken were not in line with ESGE recommendations (56/177 – 32%), of these 16/56 (34%) polypectomies involved inappropriate diathermy use which could have led to increased risk of complications such as post-polypectomy bleeding and perforation. A significant number of polyps are removed by the cold biopsy technique (25/177 – 14%) which is not advocated due to a higher risk of local recurrence. We recommend better dissemination and implementation of the ESGE guidelines to enhance clinical practice with regards to polypectomy techniques.