From detection to treatment
When a lesion is identified during gastroscopy or colonoscopy, the next question is whether it can be removed safely and completely using an endoscopic technique or whether surgery is more appropriate.
Polypectomy and EMR
Standard polypectomy is appropriate for many colorectal polyps. Endoscopic mucosal resection (EMR) is an established treatment for larger nonpedunculated colorectal lesions. ESGE's 2024 guideline recommends conventional EMR for large nonpedunculated adenomatous polyps of 20 mm or greater, while technique selection changes when superficial invasive cancer is suspected.
Endoscopic submucosal dissection (ESD)
ESD enables en-bloc removal of selected superficial gastrointestinal neoplasia, allowing detailed histological assessment of lateral and deep margins. It is used selectively according to lesion morphology, location, suspected depth of invasion and the need for en-bloc resection.
Oesophageal and gastric lesions
ESGE guidance supports endoscopic therapy for defined Barrett-related neoplasia and selected early gastric neoplasia. MAPS III recommends ESD for several categories of clinically staged superficial gastric neoplasia, with selection based on differentiation, depth, ulceration and lesion size.
Advanced resection after screening
A screening or diagnostic endoscopy may identify a lesion that requires advanced resection rather than routine polypectomy. The practice provides assessment for EMR and ESD so that complex lesions can be considered within the same advanced-endoscopy pathway.
References & clinical guidance
- ESGE Guideline Update 2024 — Colorectal polypectomy and EMR
- ESGE Guideline — Diagnosis and management of Barrett oesophagus
- ESGE/EHMSG/ESP MAPS III 2025 — Gastric precancerous conditions and early neoplasia
The wording on this page is original. Recommendations are attributed to the source where used.
This information is educational and does not replace individual clinical assessment. A request for endoscopy is reviewed clinically before a procedure is confirmed.
Screening and advanced therapeutic gastroscopy and colonoscopy
Prof Noel performs gastrointestinal cancer screening and endoscopic removal of suitable colorectal and gastric polyps and selected superficial early cancers using endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). His therapeutic practice also includes Z-POEM for selected Zenker’s diverticula, radiofrequency ablation for appropriately selected Barrett’s-related neoplasia, endoscopic stricture dilatation and other complex interventional procedures. Treatment is selected according to pathology, lesion characteristics and patient factors.