Mistakes in endoscopic resection and how to avoid them

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Mistakes in endoscopic resection and how to avoid them

Alessandro Repici, Francesco Auriemma

Summary

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This article discusses common diagnostic and therapeutic mistakes in endoscopic resection of gastrointestinal lesions and proposes approaches to avoid them based on clinical experience.

Endoscopic resection is an advanced technique used to remove superficial lesions throughout the gastrointestinal tract, including the oesophagus, stomach, duodenum, small intestine, and especially the colon.
The procedure involves a multistep process including lesion detection and characterization, use of appropriate resection devices and methods, and management of malignant polyps.
Successful endoscopic resection requires training, experience, expertise, and a multidisciplinary approach.
The authors present frequently observed mistakes in their practice that have major consequences for patients and offer experience-based strategies to avoid them.
This material is most relevant for endoscopists performing or learning advanced resection techniques.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7

Moss A, et al. Endoscopic mucosal resection outcomes and prediction of submucosal cancer from advanced colonic mucosal neoplasia. Gastroenterology 2011; 140: 1909–1918. [Link]

Rex DK, Hassan C and Bourke MJ. The colonoscopist’s guide to the vocabulary of colorectal neoplasia: histology, morphology, and management. Gastrointest Endosc Epub ahead of print 7 April 2017. DOI: http://dx.doi.org/10.1016/j.gie.2017.03.1546. [Link]

Klein A and Bourke MJ. How to perform high-quality endoscopic mucosal resection during colonoscopy. Gastroenterology 2017; 152: 466–471. [Link]

Fahrtash-Bahin F et al. Snare tip soft coagulation achieves effective and safe endoscopic hemostasis during wide-field endoscopic resection of large colonic lesions (with videos). Gastrointest Endosc 2013; 78: 158–163. [Link]

Burgess NG et al. Risk factors for intraprocedural and clinically significant delayed bleeding after wide-field endoscopic mucosal resection of large colonic lesions. Clin Gastroenterol Hepatol 2014; 12: 651–661.e3. [Link]

Hassan C, et al. Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2013; 45: 842–851. [Link]

Abstract

Endoscopic resection is a widespread, advanced endoscopic technique that can be used to remove superficial lesions in the gastrointestinal tract. Lesions present in all parts of the gastrointestinal tract, such as the oesophagus, stomach, duodenum, small intestine and, above all, colon, can be removed by endoscopic resection. Lesion detection and characterization, the use of appropriate resection devices and methods, and the management of malignant polyps are all important parts of a multistep process that requires training, experience, expertise and a multidisciplinary approach. The diagnostic and therapeutic mistakes discussed here are based on our endoscopic experience. We present the most important mistakes that are often seen in endoscopic resection in our practice and have major consequences for the patient. We propose, from our experience, a simple approach to avoid these mistakes.

Topics

Endoscopy

Citation

Auriemma F and Repici A. Mistakes in endoscopic resection and how to avoid them. UEG Education 2017; 17: 27–29

Published

2017

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UEG Mistakes In Articles

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Mistakes in transjugular intrahepatic portosystemic shunt (TIPS) in cirrhosis and how to avoid them

Kymentie Ferdinande, Alberto Zanetto, Virginia Hernández-Gea, Marco Senzolo

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7

Moss A, et al. Endoscopic mucosal resection outcomes and prediction of submucosal cancer from advanced colonic mucosal neoplasia. Gastroenterology 2011; 140: 1909–1918. [Link]

Klein A and Bourke MJ. How to perform high-quality endoscopic mucosal resection during colonoscopy. Gastroenterology 2017; 152: 466–471. [Link]

Hassan C, et al. Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2013; 45: 842–851. [Link]

Abstract

TIPS success is rarely about the procedure alone. It depends on decisions made across the entire clinical pathway.

New in the UEG "Mistakes in…" series: Ferdinande et al., present 10 common mistakes in TIPS for cirrhosis, from referral to long-term follow-up.

Key themes:

• Screen the heart first: cardiac decompensation follows TIPS in up to 20% of patients.

• Refer early: delay costs survival in refractory ascites and high-risk variceal bleeding.

• Prevent encephalopathy by design: careful selection, nutrition, rifaximin, and controlled underdilation.

• Individualise haemodynamic targets and follow up structurally.

Topics

Hepatobiliary Surgery

Published

2026

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Episode 9: Harmonising Gastroenterology Training Across Europe

Mohsan Subhani, Sophie Schlosser-Hupf, Henriette Heinrich

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Abstract

Topics

Education & Training

Published

2026

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Ten commandments of the colon

Egle Dieninyte - Misiune 1, Cesare Hassan 2

Affiliations

1 Center of hepatology, gastroenterology and dietetics, Vilnius university Santaros Klinikos, Lithuania

2 Humanitas University, Rome, Italy

Summary

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Abstract

Topics

Endoscopy

Published

2024

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UEG Online Course

accredited

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Obesity part 1: Surgical and endoscopic treatment

Alia Hadefi, Francesco Saverio Papadia

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Overview

Nearly six in ten European adults are living with overweight or obesity, and more than 1.2 million deaths a year across the region are attributable to it. In this course, Alia Hadefi (Brussels) and Francesco Saverio Papadia (Genoa) take you through the endoscopic and surgical management of severe obesity, from first referral to lifelong follow-up.

Part 1 opens with the 2025 Lancet Commission distinction between preclinical and clinical obesity, then reviews the endoscopic bariatric and metabolic therapies: intragastric balloons, endoscopic gastric remodelling with the Apollo, Endomina and POSE platforms, and small bowel devices such as the duodenal-jejunal bypass liner and duodenal mucosal resurfacing. Dedicated sessions cover endoscopic sleeve gastroplasty in MASH and revisional endoscopy for weight regain after surgery.

On the surgical side, the course sets out current IFSO/ASMBS referral thresholds, how to match sleeve gastrectomy, Roux-en-Y gastric bypass and hypoabsorptive procedures to the individual patient, preoperative optimisation and ERAS, and the atypical presentation of leaks and internal hernia. It closes with nutritional monitoring, management of gastro-oesophageal reflux disease and weight regain, combination therapy with anti-obesity medications, and a round-table on where drugs, endoscopy and surgery are heading. Part 2, on pharmacological treatment, follows in 2027.

Target Audience:

This course is suitable for:

Gastroenterologists
Bariatric surgeons
Endocrinologists
Hepatologists
Dietitians
Bariatric nurse specialists
Medical students

The Online Course on "Obesity part 1: Surgical and endoscopic treatment" is kindly supported by Boston Scientific.
Their support has been received as financial contributions only, toward the administration and technical development of these initiatives.

The development of educational content, the programme and speaker selection remain solely with UEG.

Event

Obesity part 1: Surgical and endoscopic treatment

Topics

Endoscopy Surgery

Accreditation status

accredited

Duration

1 hour

Published

2026

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UEG Standards and Guidelines

Clinical Practice Guideline

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ECCO Guidelines on the Prevention, Diagnosis, and Management of Infections in Inflammatory Bowel Disease

Henit Yanai

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Guideline

Introduction

The therapeutic landscape of inflammatory bowel disease [IBD] has undergone a profound transformation with the advent of novel immunosuppressive and biologic agents. These advancements have revolutionised the management of Crohn’s disease [CD] and ulcerative colitis [UC], enabling tighter control of inflammation and significantly improved patient outcomes. However, while older treatment strategies, including prolonged corticosteroids, purine analogues, and anti-tumour necrosis factor [TNF]/thiopurine combination therapy, carried a substantial immunosuppressive burden, the expanding therapeutic armamentarium introduces new agents with distinct infection risk profiles that require updated, evidence-based guidance. By definition, opportunistic infections are infections caused by organisms that infrequently induce disease in immunocompetent hosts but can result in significant morbidity or mortality in immunocompromised individuals. As treatment strategies increasingly rely on potent modulation of the immune system, ranging from traditional thiopurines to advanced small molecules, a structured, evidence-based approach to infection prevention, diagnosis, and management has become indispensable for the clinician. The European Crohn’s and Colitis Organisation [ECCO] has long recognised this clinical imperative, previously publishing consensus statements in 2009 and 2014, followed by a comprehensive guideline in 2021. This 2026 update is warranted by the rapid expansion of the therapeutic armamentarium, specifically the introduction of newer small molecules, advanced biologics, and evolving vaccination strategies. This update integrates the most recent data on risk stratification, viral, bacterial, mycobacterial, and vaccine-preventable infections, emphasising a preventative strategy tailored to the contemporary IBD treatment paradigm.

Publisher

European Crohn’s and Colitis Organisation

Guideline

Clinical Practice Guideline

Topics

IBD

Citation

Journal of Crohn's and Colitis, Volume 20, Issue 7, July 2026

Published

2026

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Transcriptomic dive into microscopic colitis

Celia Escudero-Hernández, Ahsen Ustaoglu

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Abstract

Topics

IBD

Published

2024

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