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Updated: May 27, 2025

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Published on: February 12, 2022
A staged approach to resecting a large rectal polyp using endoscopic mucosal resection and trans-anal endoscopic
Bhavna A Guduguntla1, Jared Yee2, Paul E Wise2
1Department of Medicine, Barnes-Jewish Hospital/Washington University in St. Louis, 660 S. Euclid Ave., MSC 8066-22-6602, St. Louis, MO 63110, United States.
Abstract:
Large rectal adenomatous polyps are not uncommon. Proctectomy sparing interventions are favored when feasible. We present a case of a 62-year-old woman, who presented with diarrhea for several years. Colonoscopy revealed a very large 60 mm rectal polyp, biopsied as tubulovillous adenoma. This was successfully resected using a staged approach with endoscopic mucosal resection and trans-anal endoscopic microsurgery. Endoscopic mucosal resection removed 70% of the lesion with central scarred not amenable to resection but amenable to transanal excision. Pathology demonstrated tubulovillous adenoma with negative margins. Flexible sigmoidoscopy at 6-month follow-up revealed well healed scar without recurrence or residual disease. This demonstrates a staged resection for a large rectal polyp which is minimally invasive and organ preserving.
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