Post written by Melissa Martinez, MD, MBA, FASGE, from Carle Foundation Hospital, Urbana, Illinois, USA.

This Best of Series article focuses on the most impactful publication topics regarding colonoscopy, periprocedural management, and resection of colonic neoplasia.

This year, many great publications continue to contribute to the wealth of knowledge and evolvement of colonoscopy. Some of these were included in this article for discussion.

The points highlighted by the reviewed publications are:

• Use of glucagon-like peptide 1 receptor agonists is a risk factor for inadequate bowel preparation, regardless of the class. Further society guidance regarding bowel preparation for colonoscopy in these patient populations may be needed.
• It seems safe to perform elective colonoscopy with polypectomy of <1 cm on anticoagulated patients at high risk for thromboembolism. Studies evaluating optimal polyp size cutoff, if any, for patients on dual antiplatelet therapy/dual agents, when the risk of thromboembolism is high, are needed.
• Prophylactic clipping after EMR is cost-effective for proximal large nonpedunculated colon polyps >20 mm, large nonpedunculated colon polyps >40 mm of any location, and large nonpedunculated colon polyps (>20 mm) in the setting of any antithrombotic medication if <2 clips are used. Studies looking at the number of clips for optimal cost-effectiveness for patients on dual antiplatelet therapy may be beneficial.
• A higher adenoma detection rate for all colonoscopies seems to be a better indicator for risk of postcolonoscopy colorectal cancer than adenoma detection rate for screening colonoscopies. This might be a call for GI societies to review the adenoma detection rate to include all colonoscopies.
• Conventional endoscopic resection techniques are an effective way to manage previously partially resected nonpedunculated colorectal lesions in the hands of expert endoscopists.
• Underwater endoscopic submucosal dissection (ESD) appears to be equally effective but more efficient than conventional ESD for removal of large colonic lesions, and the recurrence rates of horizontal macroscopically complete margin-positive en bloc ESD for noninvasive colorectal neoplasia seem to be low at 2.3%.¹ Studies evaluating lesion characteristics and optimal ESD technique as well as surveillance interval are needed.
• ESD for large distal rectal neoplasms can lead to postprocedural anorectal symptoms. Studies evaluating the best resection technique as well as the role of pelvic floor therapy for management of these are granted.
• The innovative magnetic flexible endoscope platform for colonoscopy offers a potential option to avoid instrument looping, eliminate procedural pain, obviate need for sedation, and provide a more ergonomic experience for the endoscopist. Large human studies showing its safety, efficiency, ergonomic advantage, and decreased procedural patient sedation requirements are expected.
• Endoscopic full-thickness resection appears safe and effective for the management of appendiceal orifice neoplasms and seems to be an alternative to ESD. However, endoscopists should be aware of the risk for appendicitis and postprocedural fistula. Studies evaluating the risk factors for postprocedural appendicitis after endoscopic full-thickness resection for appendiceal orifice neoplasms are needed.

Read the full article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

1. Verhoeven DA, Basiliya K, van der Krann J, et al. Local recurrence rates of horizontal margin-positive en bloc endoscopic submucosal dissection of colorectal neoplasia: a meta-analysis. Gastrointest Endosc. Epub 2025 Jun 11. ↩︎