The removal of large colon polyps during endoscopy raises a number of concerns, including the risk of the procedure and the possibility of inadequate polypectomy. The latter is particularly concerning since large polyps have an increased risk of harboring invasive carcinoma [1-5]. Endoscopic resection of large polyps, especially laterally-spreading sessile polyps, is also significantly more time-consuming and requires more resources compared with polypectomy of smaller lesions .
Because of these issues, surgical resection is often used, particularly for large sessile polyps and for those in locations that are difficult to treat endoscopically. However, endoscopic removal of the polyps may be possible if an endoscopist experienced in the removal of large colon polyps is available, avoiding the need for surgery [1-5].
This topic will review the endoscopic removal of large colon polyps. The definition of "large" varies in the literature; for the purpose of this discussion, the definition of large will refer to polyps that are ≥2.0 cm in their greatest dimension. An overview of colonoscopy and the treatment and prevention of postpolypectomy bleeding are discussed separately. (See "Overview of colonoscopy in adults" and "Bleeding after colonic polypectomy".)
Appropriate patients for endoscopic removal of large colon polyps include those in whom the concern for invasive cancer is low and the size and location of the polyp are amenable to endoscopic resection with a relatively low risk of complications. In addition, endoscopic resection may be appropriate for patients who do not meet these criteria but who are poor surgical candidates.
Features suggesting invasive cancer — Large polyps may contain cancer that is completely contained within the polyp. In these cases, polypectomy is considered curative, provided the cancer is completely contained within the resected tissue, there is no lymphovascular invasion, and the resection margins are free of cancer [7-10]. Pedunculated polyps (ie, polyps with a stalk (picture 1)) can generally be removed endoscopically, even if the polyp tissue appears malignant, provided the stalk appears normal. Sessile polyps (ie, polyps that lack a stalk (picture 2)) should only be removed endoscopically if they lack malignant features.