Standardized Assessment of Complete Colorectal Polyp Resection for Polyps <20 mm (SCOPE): a Delphi Consensus

Incomplete resection of colorectal polyps can lead to polyp recurrence and post-colonoscopy colorectal cancer. At present, standardized methods for assessing resection completeness and calculating the incomplete resection rate (IRR) are lacking. This study aimed to establish expert consensus on optimal strategies and protocols for standardized evaluation of resection completeness for resections of polyps <20 mm in size.

An international modified Delphi consensus process consisting of three rounds of anonymized surveys was conducted. A total of 103 gastrointestinal endoscopy experts were invited. Agreement was defined as consensus among >80% of participants for each statement. Based on expert consensus, standardized assessment protocols were established for daily clinical practice, and for quality assurance and research.

Sixty-seven experts from 18 countries participated, with 53 (51%) from 16 countries completing all three rounds. Consensus was achieved for 18 of 20 (90%) statements after three rounds. Key agreements included: (1) primary assessment of resection completeness using high-definition white-light inspection, supplemented by image-enhanced inspection for polyps 10-19 mm; (2) routine post-resection photo documentation for polyps 10-19 mm; (3) standard histopathological margin assessment for all non-fragmented 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 10-19 mm.

This study presents international expert consensus on evaluation of resection completeness for colorectal polyps <20 mm in size. Provided recommendations could guide more consistent and standardized evaluation of polyp resections and support establishment of the IRR as a valuable quality parameter for colonoscopy.