Table 2.

Modified SMSA scoring to help management of colonic polyps

Level	Type of polyp	SMSA	Setting/endoscopist
1	Lesions <10 mm in diameter	4–5	Flexible sigmoidoscopy screening
2	Polypoid and sessile lesions <20 mm providing there is good access.	6–8	All colonoscopists
3	Flat lesions (<20 mm) that are suitable for endoscopic therapy, larger sessile and polypoid lesions and smaller lesions with more difficult access	9–12	Faecal immunochemical testing screening positive colonoscopy
4	Larger flat lesions (>20 mm) or other challenging polypoid lesions (site, size or access)	12–17	Regionally based colonoscopists Polyp MDT
5	Flat lesions >40 mm Levels 2, 3 or 4 lesions with: Previous intervention Direct ileocaecal valve, diverticular or appendiceal involvement Morphology flat/depressed or LST-NG or LST-G+1 s NICE III, Pit pattern Vi	NA	Supraregional endoscopists Polyp MDT Endoscopic submucosal dissection option Surgical option

LST, laterally spreading tumour; LST-G, granular LST; LST-NG, non-granular LST; MDT, multidisciplinary team; SMSA, size, morphology, site and access.