Standardized Assessment of Complete Colorectal Polyp Resection for Polyps Less Than Twenty Millimeters: A Delphi Consensus

BACKGROUND & AIMS: The incomplete resection of colorectal polyps can lead to polyp recurrence and postcolonoscopy colorectal cancer. At present, standardized methods for assessing the completeness of the resection and calculating the incomplete resection rate (IRR) are lacking. This study aimed to establish an expert consensus on the optimal strategies and protocols for the standardized evaluation of resection completeness for resections of polyps <20 mm in size. METHODS: An international modified Delphi consensus process consisting of 3 rounds of anonymized surveys was conducted. A total of 103 gastrointestinal endoscopy experts were invited. Agreement was defined as consensus among ≥80% of the participants for each statement. Based on the expert consensus, standardized assessment protocols were established for daily clinical practice and for quality assurance and research. RESULTS: Sixty-seven experts from 18 countries participated, with 53 (51%) from 16 countries completing all 3 rounds. Consensus was achieved for 18 of 20 statements (90%) after 3 rounds. The key agreements included: (1) the primary assessment of resection completeness using high-definition white-light inspection, supplemented by image-enhanced inspection for polyps 10 to 19 mm; (2) routine postresection photo documentation for polyps 10 to 19 mm; (3) standard histopathologic margin assessment for all nonfragmented and en bloc resected polyps; (4) preferential IRR measurement using extended margin resection; and (5) the need for endoscopists to know and monitor their personal IRR for polyps 10 to 19 mm. CONCLUSIONS: This study presents an international expert consensus on the evaluation of the completeness of resections for colorectal polyps <20 mm in size. The recommendations provided could guide more consistent and standardized evaluation of polyp resections and support the establishment of the IRR as a valuable quality parameter for colonoscopy.