We aimed to assess the current practice in terms of polypectomy technique of SSL in comparisons to the ESGE standards. 

A single centre, retrospective analysis of consecutive patients who have had polypectomies done for SSL 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 ESGE recommendation on polypectomy technique for SSL. 

Of 177 polypectomies, 18 SSLs of varying sizes were confirmed at histology. 13 of these (72%) were retrieved using cold snare polypectomy with or without EMR, in line with ESGE guidelines. The remaining 5 SSLs (28%) were retrieved using either hot EMR or cold biopsy. 

Sessile serrated lesions (SSL) have been recognised in the last decade as important premalignant lesions accounting for between 15% and 30% of colorectal cancers. According to European Society of Gastrointestinal Endoscopy (ESGE) guidelines, cold snare polypectomy is recommended for SSLs < 10mm, and cold snare polypectomy or piecemeal cold snare polypectomy with or without endoscopic mucosal resection (EMR) technique for SSL <19mm. This technique is adopted to reduce thermal damage from diathermy techniques reducing the complications of delayed bleeding and perforation. 

Through this study, we can conclude that a significant proportion of SSLs are still being extracted using methods inclined to increase thermal damage. The current ESGE guidelines, with-regards-to SSL polypectomies has not been fully implemented in clinical practice. We recommend better dissemination and implementation of these guidelines, which in turn, could lead to reduced iatrogenic perforation rates and cases of post-procedural bleeding, as well as cost savings in using less resource