The evidence on endoscopic full thickness removal of non-lifting colonic polyps raises some major safety concerns. Current evidence on efficacy is inadequate in quantity and quality. Therefore, this procedure should not be used unless there are special arrangements for clinical governance, consent, and audit or research.
Clinicians wishing to do endoscopic full thickness removal of non-lifting colonic polyps should:
Inform the clinical governance leads in their NHS trusts.
Ensure that patients understand the uncertainty about the procedure's safety and efficacy, and provide them with clear written information. In addition, the use of NICE's information for the public is recommended.
Audit and review clinical outcomes of all patients having endoscopic full thickness removal of non-lifting colonic polyps (see section 6.1).
Patient selection should be done by a polyp and early colorectal cancer multidisciplinary team. Only clinicians with specific training should do this procedure.
NICE encourages further research and data collection on endoscopic full thickness removal of non-lifting colonic polyps and may update the guidance on publication of further evidence. This should include safety and efficacy outcomes such as perforation, bleeding, the need for immediate re‑intervention, inadequate resection and longer-term follow‑up of patients found to have malignant disease.