ESGE Endorses Resect and Discard in Routine Practice

ESGE Endorses Resect and Discard in Routine Practice

Douglas K. Rex, MD, FASGE reviewing Bisschops R, et al. Endoscopy 2019 Nov 11.

The European Society of Gastrointestinal Endoscopy (ESGE) has issued an updated guideline on imaging of colorectal neoplasia. Highlights of the recommendations include:

  • Real-time optical diagnosis of diminutive (≤5 mm) polyps can replace histopathological diagnosis. The optical diagnosis must be reported using a validated scale and documented by photo and can be performed only by experienced and adequately trained endoscopists. Performance should be audited.
  • Computer-aided diagnosis (artificial intelligence [AI]) appears promising for detection and characterization, but risks, such as deskilling, overreliance on AI, and unrepresentative training data sets, need further consideration.
  • High-definition scopes are endorsed for detection, particularly in patients with Lynch syndrome.
  • Chromoendoscopy is endorsed in IBD that is quiescent and has good bowel preparation, with abandonment of non-targeted biopsies. ESGE found insufficient evidence to recommend against virtual chromoendoscopy in quiescent IBD.
  • Laterally spreading lesions should be thoroughly examined with high-definition white-light and virtual chromoendoscopy for evidence of deep submucosal invasion prior to endoscopic resection.

This is a useful evidence-based summary of the role of specialized imaging in detection and diagnosis in the colorectum.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

Douglas K. Rex, MD, FASGE


Bisschops R, East JE, Hassan C, et al. Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2019. Endoscopy 2019 Nov 11. (Epub ahead of print) (

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