Guideline update: imaging in colorectal neoplasia

  • Bisschops R & al.
  • Endoscopy
  • 11 Nov 2019

  • curated by Emily Willingham, PhD
  • Univadis Clinical Summaries
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Takeaway

  • The European Society of Gastrointestinal Endoscopy (ESGE) has published updated guidelines for using advanced imaging to detect and differentiate colorectal neoplasias.

Why this matters

  • With rollout of new advances in imaging, endoscopists have some guidance on applications and interpretations.

Key guidance

  • High-definition endoscopy, with dye/virtual chromoendoscopy and add-on devices, is acceptable for adenoma detection in patients at average risk, considering costs, practicalities (weak recommendation/high-quality evidence).
  • Routine use of high-definition systems in Lynch syndrome is recommended (strong/high-quality).
  • Routine targeted biopsy or dye-based/virtual chromoendoscopy in long-standing colitis recommended (strong/moderate-quality).
  • Virtual or dye-based chromoendoscopy OK under strict controls and with extensive experience for diagnosis of very small polyps (≤ 5  mm; weak/high-quality).
  • High-definition white-light endoscopy+chromoendoscopy for characterizing submucosal invasion (strong/moderate-quality).
  • Chromoendoscopy+white-light endoscopy for residual neoplasia at site of piecemeal polypectomy (strong/moderate-quality).
  • Computer-aided diagnosis possible but carries significant implementation risks (weak/low-quality).