Korean guideline for colonoscopic polypectomy

Abstract

There is indirect evidence 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 outpatient clinics and secondary and tertiary 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; Guideline; Polypectomy.

Fig. 1

Efficacy of prophylactic saline with epinephrine injection prior to snare polypectomy for the prevention of overall bleeding (early and late). CI, confidence interval.

Fig. 2

Efficacy of prophylactic saline with epinephrine injection prior to snare polypectomy for the prevention of early bleeding. CI, confidence interval.

Fig. 3

Efficacy of prophylactic saline with epinephrine injection prior to snare polypectomy for the prevention of late bleeding. CI, confidence interval.

Fig. 4

Efficacy of the prophylactic method (endoloop or clip application) for the prevention of early bleeding in cases with large pedunculated polyps. CI, confidence interval.

Fig. 5

Efficacy of the prophylactic method (endoloop or clip application) for the prevention of delayed bleeding in cases with large pedunculated polyps. CI, confidence interval.

Fig. 6

Subgroup analysis of prophylactic methods versus submucosal injections for the prevention of early bleeding. CI, confidence interval.

Fig. 7

Subgroup analysis of prophylactic methods versus submucosal injections for the prevention of delayed bleeding. CI, confidence interval.

Fig. 8

Subgroup analysis of the prophylactic method versus no injection for the prevention of early bleeding. CI, confidence interval.

Fig. 9

Subgroup analysis of the prophylactic method versus no injection for the prevention of delayed bleeding. CI, confidence interval.

Fig. 10

Efficacy of the prophylactic method (argon plasma coagulation or clip application) for the prevention of delayed bleeding. CI, confidence interval.