Young gastroenterologists dealing with polyps: a multicenter pilot study on training in polypectomy in Greece

Aims This study aims to assess whether young gastroenterologists are adequately trained in the management of colorectal polyps and to what extent they adhere to current guidelines in polypectomy.

Methods Fourteen gastroenterologists from 14 different hospitals across the country participated in a polypectomy training course that included live demonstration of polypectomy procedures. The participants were either in their 3rd or 4th year of residency or were young specialists. During the course, experienced endoscopists performed basic polypectomies, which were broadcast to a teaching room. Participants were provided with a questionnaire covering all potential techniques recommended by the ESGE guidelines, which they were required to complete before each demonstration [1].

Results All polyps were located in the colon and classified according to the Paris classification. Endoscopists used dye-based (indigo carmine) and virtual chromoendoscopy to assess the possibility of submucosal invasion and to characterize lesions. The lesions ranged from sessile or flat polyps (5–30 mm) to large pedunculated polyps (head size≥20 mm). Polypectomies were performed according to the latest ESGE guidelines, with interactive discussions between endoscopists and trainees. Various techniques were used, including cold snare polypectomy, piecemeal cold snare, cold EMR, en-bloc EMR, hot snare and EMR following prophylactic mechanical hemostasis with an endoloop. Participants chose the technique they deemed most appropriate before the experienced endoscopist performed the procedure. Agreement with the ESGE guidelines was achieved by 92.8% (8/9) of the trainees, except in the case of a 15-mm flat lesion (Paris 0-IIa, NICE: 1) located at the ileocecal valve, which was removed by cold EMR after submucosal injection for margin demarcation. For this particular lesion, the majority of participants (10 out of 14) preferred conventional EMR.

Conclusions Young gastroenterologists demonstrate a strong familiarity with the polypectomy techniques outlined in the updated ESGE guidelines. The only area of concern is the use of cold snare polypectomy for sessile serrated lesions (SSLs)≥10 mm. This discrepancy may be attributed to limited experience with chromoendoscopy for identifying these lesions and detecting associated dysplasia.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

• 1 Colorectal polypectomy and endoscopic mucosal resection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2024