Endoscopic Resection of Moderate and Large Colorectal Polyps

摘要

Endoscopic resection is the gold standard for medium and large colorectal polyps. Size is not anymore a limit for endoscopic resection, only deep submucosal infiltration with risk of lymph node involvement is a carcinological limit. This submucosal infiltration could be accurately predicted by mucosal and vascular patterns analysis with virtual chromoendoscopy using high definition scopes. Standard polypectomy, endoscopic mucosal resection (en bloc or piece meal) and endoscopic submucosal dissection are the available endoscopic resection strategies available for large superficial colorectal lesions. Knowledge of resection strategies and techniques, tips and tricks facilitating these procedures should allow any gastroenterologist involved in the colorectal cancer screening campaign to take care of medium-sized polyps (10-20 mm) by appropriate technique. For large polyps (> 20 mm), expert centers are available throughout the country to ensure the most suitable care for patients and avoid more morbid and more expensive surgery and must be reserved for failure or carcinological limits of endoscopic resection techniques. This article details the indications and the resection strategies for these superficial lesions according to their morphology and theoretical cancer risk.