An international Delphi panel of 53 experienced endoscopists from 16 countries has proposed standardized practices for confirming complete removal of colorectal polyps smaller than 20 mm. The consensus recommends removing 10–19 mm polyps with at least a 1-mm margin, carefully inspecting the resection defect, and documenting the site with before-and-after photographs. The panel said an endoscopist’s incomplete resection rate (IRR) for 10–19 mm polyps should not exceed 10%, with a preferred target below 5%.
The recommendations emphasize that simply looking at the defect may not always be enough. Water-jet inspection after cold-snare resection and image enhancement or magnification for 10–19 mm polyps were recommended, while histopathologic margin assessment was supported when technically feasible. Routine biopsy of resection defects, however, was not recommended in daily practice.
The panel’s Aasma Shaukat noted that incomplete resection rates may be higher than generally recognized and can contribute to post-colonoscopy colorectal cancers. Measuring IRR could help identify endoscopists who need targeted training, although the 10% threshold is based on expert opinion rather than direct clinical-outcome evidence. The authors also stressed that these are expert-consensus recommendations, not formal society guidelines, and that further studies are needed to validate the threshold and determine whether implementing the protocols reduces recurrence and post-colonoscopy CRC.