From the Guidelines
The management of colonic polyps typically involves endoscopic removal, with the goal of preventing colorectal cancer.
Key Considerations
- For diminutive (5 mm) and small (6–9 mm) lesions, cold snare polypectomy is recommended due to high complete resection rates and safety profile 1.
- For non-pedunculated (10–19 mm) lesions, cold or hot snare polypectomy (with or without submucosal injection) is suggested 1.
- For non-pedunculated (20 mm) lesions, endoscopic mucosal resection (EMR) is recommended as the preferred treatment method, with the goal of complete resection and minimizing the risk of surgical complications 1.
Additional Recommendations
- Photo documentation of all lesions ≥ 10 mm in size before removal, and of the post-resection defect, is recommended 1.
- Proficiency in the use of electronic- or dye-based image-enhanced endoscopy techniques is suggested to apply optical diagnosis classifications for colorectal lesion histology 1.
- Adjuvant thermal ablation of the post-EMR margin may be considered in cases where no endoscopically visible adenoma remains despite meticulous inspection 1.
- Prophylactic closure of resection defects ≥ 20 mm in size in the right colon is suggested when closure is feasible 1.
Malignant Polyps
- The management of malignant polyps requires a thorough and knowledgeable endoscopic assessment to identify features of deep submucosal invasion, and may involve surgical resection in cases with unfavorable histologic features or high risk of residual cancer 1.
- Shared decision-making is emphasized in cases where the risk of residual cancer and the risk of surgical mortality are similar, taking into account patient values and preferences 1.