1. A structured visual assessment using high-definition white light and/or electronic chromoendoscopy and with photo documentation should be conducted for all polyps found during routine colonoscopy. Closely inspect colorectal polyps for features of submucosally invasive cancer.
2. Use cold snare polypectomy for polyps <10 mm in size. Cold forceps polypectomy can alternatively be used for 1- to 3-mm polyps where cold snare polypectomy is technically difficult.
3. Do not use hot forceps polypectomy.
4. Clinicians should be familiar with various techniques, such as cold and hot snare polypectomy and endoscopic mucosal resection, to ensure effective, safe, and optimal resection of intermediate-size polyps (10–19 mm).
5. Consider using lifting agents or underwater endoscopic mucosal resection for removal of sessile polyps 10–19 mm in size.
6. Serrated polyps should be resected using cold resection techniques. Submucosal injection may be helpful for polyps >10 mm if margins cannot be well delineated.
7. Use hot snare polypectomy to remove pedunculated lesions >10 mm in size.
8. Do not routinely use clips to close resection sites for polyps <20 mm.
9. Refer patients with polyps to endoscopic referral centers in the context of size ≥20 mm, challenging polypectomy location, or recurrent polyp at a prior polypectomy site.
10. Tattoo lesions that may need future localization at endoscopy or surgery. Tattoos should be placed in a location that will not interfere with subsequent attempts at endoscopic resection.
11. Refer patients with nonpedunculated polyps with clear evidence of submucosally invasive cancer for surgical evaluation.
12. Understand the endoscopy suite’s electrosurgical generator settings appropriate for polypectomy or post-polypectomy thermal techniques.
