We aimed to assess the current practice in our institution in terms of polypectomy technique of right sided polyps in comparisons to the ESGE standards.

A single centre, retrospective analysis of 100 consecutive patients who have had polypectomy of any size from April 2024 at a hospital in North London was undertaken. Patients who had polypectomy from the right side of the colon, defined as polyps in the caecum, ascending colon and hepatic flexure, were then analysed. 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 obedience of ESGE guidance on polypectomy technique.

A total of 70 right sided polyps were detected and analysed from polypectomies across the 100 patients. Of those, 53 polypectomies (76%) followed ESGE recommendations and 17 (24%) did not. The non-compliant polypectomy methods used included cold biopsy, hot endoscopic mucosal resection (EMR) for SSL or polyps less than 10mm and hot snare for polyps less than 10mm (see Table).

Polypectomy on the right side of the colon pose a challenge due to its thin wall increasing the risk of perforation. New guidelines from the European Society of Gastrointestinal Endoscopy (ESGE) recommend using cold snare polypectomy in polyps <10mm, as well as use of cold snare polypectomy technique for serrated sessile lesions (SSL) of all sizes to reduce the risk of delayed bleeding. The guidance also recommends avoiding cold biopsy for polyp resection to reduce the risk of recurrence.

This study shows insufficient compliance to the ESGE guidelines in our department with regards to polypectomies performed on right side of the colon. Almost a third of polypectomies not in line with ESGE guidance (5/17) involved inappropriate diathermy use, which may have increased the risk of perforation. Although, these risks can be mitigated slightly through prophylactic use of clips, this is less cost effective and could be avoided through increased use of cold EMR or cold snare polypectomy in the right colon for smaller polyps. In addition, many endoscopists are still carrying out cold biopsies on small polyps(8/70, 11%), which ESGE recommends avoiding due to the likelihood of incomplete resections and therefore increased risk of local recurrence. We conclude that there is inadequate adherence to the latest ESGE guidelines with regards to right sided polypectomies. We recommend better dissemination and implementation of the ESGE guidelines to enhance clinical practice with regards to polypectomy techniques.