Approaches to assessing completeness of colorectal polyp resections in clinical practice: a systematic scoping review

Background: Protocols for standardized assessment of complete colorectal polyp resection are lacking, contributing to divergent quality standards and hindering reliable comparison of incomplete resection rates (IRRs) across resection devices, techniques, endoscopists, and institutions. We reviewed available methods to inform the development of such protocols. Methods: We systematically searched MEDLINE, Embase, Web of Science, and Cochrane Library databases from inception to 30 July 2024. Studies describing the use or validation of methods for assessing completeness of polyp resection were included. Studies using recurrence detected at follow-up or histopathological resection specimen margin assessment as outcome measures were excluded, unless used as reference standards for evaluation of other methods. Results: 45 eligible studies were identified. Methods for assisting in visual confirmation of complete resection included image enhancement techniques (6 studies), artificial intelligence (1 study), and resection defect diameter (1 study). Methods for measuring IRRs based on a histopathological reference standard involved biopsy sampling (29 studies) and extended margin resection (8 studies). IRR measurement protocols differed in terms of factors such as location and number of biopsies (1-8) and widths of extended resections (1-3 mm). IRRs >10% were observed for all polyp size categories and almost all resection techniques, with considerable variability in IRRs reported across studies (biopsy sampling 0-24.2%; extended resection 0-61.1%). Conclusions: Different methods are available to assist in visual confirmation of complete resection and measuring IRRs, with considerable variability in their application, highlighting the need for standardized assessment of complete colorectal polyp resection.