Large nonpedunculated colorectal polyp management through the lens of an interventional endoscopist

Minimally invasive endoscopic resection techniques are now the first-line management strategy for most large (> 20 mm) nonpedunculated colorectal polyps (LNPCPs). Appropriate technique selection depends on optical evaluation to predict lesion histopathology alongside the presence of and depth of malignant invasion. We review the indications and performance of endoscopic mucosal resection, cold snare resection, and endoscopic submucosal dissection. These complementary techniques, bolstered by site-specific technical modifications and ancillary techniques, are an effective, efficient, and safe alternative to surgery. An understanding of the role of minimally invasive endoscopic resection techniques is crucial for all endoscopists and surgeons involved in LNPCP management.