The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Endoscopic submucosal dissection of lower gastrointestinal lesions.


This procedure can be used to treat superficial colon lesions. The procedure involves inserting a long camera (colonoscope) through the anus as far as the caecum. A solution is injected submucosally to raise the area affected by the lesion, which is resected endoscopically.  The aim of the procedure is to fully remove the lesion without the need for open surgery, and to obtain a good quality sample for histological examination.

Coding recommendations

One of the following OPCS-4 codes is selected:

H20.5 Fibreoptic endoscopic submucosal resection of lesion of colon

H23.5 Endoscopic submucosal resection of lesion of lower bowel using fibreoptic sigmoidoscope

H26.6 Endoscopic submucosal resection of lesion of sigmoid colon using rigid sigmoidoscope

Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

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