Endoscopy 2019; 51(12): 1155-1179
DOI: 10.1055/a-1031-7657
© Georg Thieme Verlag KG Stuttgart · New York

Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2019

Raf Bisschops
1   University Hospitals Leuven, Department of Gastroenterology and Hepatology, TARGID, KU Leuven, Belgium
James E. East
2   Translational Gastroenterology Unit, Nuffield Department of Medicine, Experimental Medicine Division, John Radcliffe Hospital, University of Oxford, Oxford, UK
3   Oxford National Institute for Health Research Biomedical Research Centre, Oxford, UK
Cesare Hassan
4   Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
Yark Hazewinkel
5   Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, The Netherlands
Michał F. Kamiński
6   Department of Gastroenterological Oncology, the Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
7   Department of Gastroenterology, Hepatology and Oncology, Medical Center for Postgraduate Education, Warsaw, Poland
8   Institute of Health and Society, University of Oslo, Oslo, Norway
Helmut Neumann
9   Department of Medicine I, University Medical Center Mainz, Mainz, Germany
Maria Pellisé
10   Department of Gastroenterology. Institut Clinic de Malalties Digestives I Metabòliques, Hospital Clinic of Barcelona, Barcelona, Spain
11   Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
Giulio Antonelli
12   Endoscopy Unit, Sant'Andrea University Hospital, “Sapienza” University of Rome, Rome, Italy
Marco Bustamante Balen
13   Gastrointestinal Endoscopy Unit, Digestive Diseases Department, La Fe Polytechnic University Hospital, Valencia, Spain
14   Gastrointestinal Endoscopy Research Group, La Fe Health Research Institute, Valencia, Spain
Emmanuel Coron
15   CHU Nantes, Université Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), Nantes, France
Georges Cortas
16   Division of Gastroenterology, University of Balamand Faculty of Medicine, St. George Hospital University Medical Center, Beirut, Lebanon
Marietta Iacucci
17   Institute of Translational of Medicine, Institute of Immunology and Immunotherapy and NIHR Biomedical Research Centre, University of Birmingham and University Hospitals, Birmingham NHS Foundation Trust, UK
Mori Yuichi
18   Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
Gaius Longcroft-Wheaton
19   Portsmouth Hospitals NHS Trust, Cosham, Portsmouth, UK
Serguei Mouzyka
24   National Medical Academy of Postgraduate Education, Kyiv, Ukraine
Nastazja Pilonis
20   Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
21   Department of Gastroenterology, Hepatology and Oncology, Medical Center for Postgraduate Education, Warsaw, Poland
Ignasi Puig
22   Digestive Diseases Department, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain
23   Department of Medicine, Facultat de Ciències de la Salut, Universitat de Vic-Universitat Central de Catalunya (UVic-UCC), Manresa, Spain
Jeanin E. van Hooft
5   Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, The Netherlands
Evelien Dekker
5   Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, The Netherlands
› Author Affiliations
Further Information

Publication History

Publication Date:
11 November 2019 (online)

Main Recommendations

1 ESGE suggests that high definition endoscopy, and dye or virtual chromoendoscopy, as well as add-on devices, can be used in average risk patients to increase the endoscopist’s adenoma detection rate. However, their routine use must be balanced against costs and practical considerations.

Weak recommendation, high quality evidence.

2 ESGE recommends the routine use of high definition systems in individuals with Lynch syndrome.

Strong recommendation, high quality evidence.

3 ESGE recommends the routine use, with targeted biopsies, of dye-based pancolonic chromoendoscopy or virtual chromoendoscopy for neoplasia surveillance in patients with long-standing colitis.

Strong recommendation, moderate quality evidence.

4 ESGE suggests that virtual chromoendoscopy and dye-based chromoendoscopy can be used, under strictly controlled conditions, for real-time optical diagnosis of diminutive (≤ 5 mm) colorectal polyps and can replace histopathological diagnosis. The optical diagnosis has to be reported using validated scales, must be adequately photodocumented, and can be performed only by experienced endoscopists who are adequately trained, as defined in the ESGE curriculum, and audited.

Weak recommendation, high quality evidence.

5 ESGE recommends the use of high definition white-light endoscopy in combination with (virtual) chromoendoscopy to predict the presence and depth of any submucosal invasion in nonpedunculated colorectal polyps prior to any treatment.

Strong recommendation, moderate quality evidence.

6 ESGE recommends the use of virtual or dye-based chromoendoscopy in addition to white-light endoscopy for the detection of residual neoplasia at a piecemeal polypectomy scar site.

Strong recommendation, moderate quality evidence.

7 ESGE suggests the possible incorporation of computer-aided diagnosis (detection and characterization of lesions) to colonoscopy, if acceptable and reproducible accuracy for colorectal neoplasia is demonstrated in high quality multicenter in vivo clinical studies. Possible significant risks with implementation, specifically endoscopist deskilling and over-reliance on artificial intelligence, unrepresentative training datasets, and hacking, need to be considered.

Weak recommendation, low quality evidence.

Supplementary material

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