Endoscopic Recognition and Management Strategies for Malignant Colorectal Polyps
Publication Date: November 3, 2020
Last Updated: March 14, 2022
Recommendations
We recommend that both pedunculated and nonpedunculated polyps with the following features be considered to have deep submucosal invasion: NICE classification type 3 or Kudo classification of type V (VN and VI). (High, Strong)
612
Nonpedunculated lesions with these features should be biopsied (in the area of surface feature disruption), tattooed (unless in or near the cecum), and referred to surgery. Pedunculated polyps with features of deep submucosal invasion should undergo endoscopic polypectomy. (Low, Conditional (weak))
612
LST-NG morphology with sessile shape or depression, and LST-G with a dominant nodule predict a higher risk of submucosally invasive cancer. (Moderate, Conditional (weak))
612
We recommend that such lesions be considered for en bloc endoscopic resection, instead of piecemeal resection, when feasible and based on local expertise. In the case of LST-G with a dominant nodule, at least the nodular area should be considered for en bloc resection. All pedunculated polyps, even if large, should be resected en bloc. (Low, Conditional (weak))
612
We recommend that specimens with features associated with submucosally invasive cancer that are removed en bloc be handled in ways to optimize specimen orientation and pathologic assessment. (Low, Conditional (weak))
612
We recommend that nonpedunculated malignant polyps be considered high risk for residual or recurrent cancer if they have any of the following features: poor tumor differentiation, lymphovascular invasion, submucosal invasion depth >1 mm, tumor involvement of the cautery margin, or tumor budding. (Moderate, Strong)
612
We recommend that pedunculated malignant polyps be considered at high risk of residual or recurrent cancer if they have any of the following features: poor tumor differentiation, lymphovascular invasion, tumor within 1 mm of the resection margin. (Moderate, Strong)
612
We recommend that the pathology report adhere to the recommendation of the College of American Pathologists structured template and that the report contain the histologic type, grade of differentiation, tumor extension/invasion, stalk and mucosal margin status, as well as the presence or absence of lymphovascular invasion. We suggest other aspects, such as specimen integrity, polyp size, polyp morphology, and tumor budding be included. (Low, Conditional (weak))
612
We suggest establishing methods of communication among the gastroenterologist, pathologist, oncologist, surgeon, and the patient for the management of patients with malignant polyps. (Low, Conditional (weak))
612
Recommendation Grading
Overview
Title
Endoscopic Recognition and Management Strategies for Malignant Colorectal Polyps
Authoring Organizations
American College of Gastroenterology
American Gastroenterological Association
American Society for Gastrointestinal Endoscopy
Publication Month/Year
November 3, 2020
Last Updated Month/Year
July 8, 2024
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Male, Female, Adult, Older adult
Health Care Settings
Ambulatory, Emergency care, Hospital
Intended Users
Nurse, nurse practitioner, physician, physician assistant, social worker
Scope
Assessment and screening, Management
Diseases/Conditions (MeSH)
D011127 - Polyps
Keywords
colorectal cancer, colonoscopy, Polypectomy, endoscopic mucosal resection, Malignant Polyp, Submucosal Invasion, Histology
Supplemental Methodology Resources
Methodology
Number of Source Documents
82
Literature Search Start Date
December 31, 1979
Literature Search End Date
December 30, 2018