A Pragmatic approach to complex colon polyps

Abstract

Endoscopic resection (ER) of complex colon polyps is safe and effective. Techniques of ER include endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). The majority of polyps encountered have low risk of submucosal invasion (SMI) and thus are suitably treated by EMR. Polyps with increased risk of superficial SMI are best removed en bloc as this allows accurate staging and potential cure. Polyps with suspected superficial SMI that are =20 mm in size are resectable by EMR, but larger lesions require resection by ESD. Polyps with obvious SMI, such as depressed lesions with disrupted surface pit pattern, require surgical resection. This chapter discusses endoscopic assessment of large colonic polyps, technical aspects of EMR and ESD and techniques to prevent and manage ER-related complications.