Colon polyp
ICD-10 K63.5
ICD-11 DB35
Treatment of Non-Pedunculated Benign Colorectal Adenoma <10 mm Without Malignant Features on Colonoscopy
Clinical Scenario
This protocol covers patients found on colonoscopy to have a non-pedunculated benign colorectal adenoma measuring less than 10 mm, where the lesion is not of the flat and depressed morphological type and carries no colonoscopic features suspicious for carcinoma.
Precise characterisation of lesion morphology and size at colonoscopy is essential to applying this protocol correctly, particularly to distinguish lesions from flat/depressed-type or potentially malignant polyps, for which a different approach applies.
Approach
For adenomas meeting these criteria, the recommended removal strategy involves a cold snare technique performed with a dedicated snare — with the specific indication within this approach depending on exact lesion size.
References
DOI: 10.1007/s00535-021-01776-1
- Cold snare polypectomy (CSP) is indicated for non-pedunculated benign adenomas <10 mm in size (recommendation weak [agreement rate 100%], level of evidence B).
- CSP should be avoided for "flat and depressed-type" lesions and lesions suspected of being carcinoma on colonoscopy even if ≤5 mm in size (recommendation weak [agreement rate 100%], level of evidence B).
- CSP is recommended for diminutive lesions ≤5 mm in size and is acceptable for 6–9-mm lesions (recommendation strong [agreement rate 100%], level of evidence B).