What is a sessile polyp?

From the Guidelines

Sessile polyps should be removed using techniques such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), and the decision for adjuvant surgical resection should be individualized based on patient factors and polyp features, as recommended by the US Multi-Society Task Force on Colorectal Cancer 1. When managing sessile polyps, it is essential to consider the risk of residual cancer or recurrence after endoscopic resection versus the risk of surgical resection. The decision to recommend adjuvant surgery is based on polyp shape, whether there was en bloc resection and adequate histologic assessment, the presence or absence of unfavorable histologic features, the patient’s risk for surgical mortality and morbidity, and patient preferences 1.

Key Considerations

• The removal of sessile polyps is crucial because some types, particularly sessile serrated adenomas, carry a risk of developing into colorectal cancer.
• After removal, the tissue should be sent for pathological examination to determine if it contains precancerous or cancerous cells.
• Follow-up colonoscopies are usually recommended based on the size, number, and histology of the polyps found, with intervals ranging from 1-10 years depending on these risk factors.
• For sessile polyps 10–19 mm in size, consider using lifting agents or underwater EMR (u-EMR) for removal, as recommended by the AGA clinical practice update 1.

Management Strategies

• The goal of management of malignant polyps is to reduce over- and underuse of surgery, while minimizing the chances of recurrent or metastatic cancer 1.
• In cases where the patient’s comorbid disease might be significant and life expectancy is decreased, the endoscopist should be prepared to coordinate patient care and decision-making 1.
• The overall mortality after colon cancer surgery correlates with patient age and is 1%–8% 1.
• The decision to recommend adjuvant surgery should be individualized based on patient factors, such as age, comorbidity, and patient preferences, and polyp features, such as size and histology 1.

From the Research

Definition and Characteristics of Sessile Polyps

• Sessile polyps are a type of colorectal polyp that are flat and do not have a stalk 2
• They can be benign or malignant, and their removal is important to prevent colon cancer 2, 3
• Sessile polyps can be removed colonoscopically, but larger lesions may require laparotomy 2

Removal Techniques for Sessile Polyps

• Colonoscopic excision is a common method for removing sessile polyps, with a success rate of 79% in one study 2
• Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are also used to remove large and flat lesions 3
• Cold snare polypectomy (CSP) and cold endoscopic mucosal resection (C-EMR) are effective and safe methods for removing non-pedunculated colorectal polyps of 10-19 mm 4

Challenges and Risks Associated with Sessile Polyp Removal

• Large polyps have a higher risk of harboring malignancy and complications with resection 3
• Incomplete polyp removal can attenuate the effect of screening and increase the risk of colon cancer 5
• Serrated histology and hyperplastic histology are independent risk factors for incomplete removal 5

Surveillance and Follow-up

• Patients with confirmed sessile serrated adenomas or polyps (SSA/Ps) should undergo surveillance at intervals similar to those recommended for patients with conventional adenomas 6
• Surveillance colonoscopy can help detect recurrent polyps or cancer, and patients with SSA/Ps may be able to lower their risk of future polyps by targeting modifiable risk factors 6