Management of an endoscopically visible lesion found during surveillance colonoscopy for inflammatory bowel disease

EMR: endoscopic mucosal resection; ESD: endoscopic submucosal dissection.
* A concentrated dye (ie, indigo carmine or methylene blue) can be used to enhance visualization of the lesion.
¶ A polypoid lesion can be either sessile or pedunculated. A nonpolyoid lesion can be slightly elevated, flat, or depressed. Refer to UpToDate content on description and classification of endoscopically visible lesions.
Δ Methods of resection include snare polypectomy or endoscopic mucosal resection (may require referral to endoscopist skilled in advanced endoscopic techniques).
◊ Following polypectomy, biopsies are taken of flat, normal appearing mucosa surrounding the resection site. Biopsies are placed in a container separate from polypectomy specimen. For larger lesions resected with EMR, ESD, and/or piecemeal techniques and that require closer surveillance, place tattoo 3 to 5 cm distal to resection site if needed.
§ Features of submucosal invasion include: Depressions, failure to lift with submucosal injection, or overlying ulceration. Of note, lesions in an area of inflammation may be fibrotic and result in a falsely positive non-lifting sign. Areas of inflammation may also be ulcerated.
¥ If lesion has features of submucosal invasion, biopsy the lesion and tattoo the mucosa 3 to 5 cm distal to the site. If the lesion is discrete, refer the patient to advanced endoscopist to assess for endoscopic resection.
‡ Multidisciplinary review includes referral to advanced endoscopist and/or colorectal surgery for further management options.