Endoscopic approach to large non-pedunculated colorectal polyps

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Oncology

Background:

• Large non-pedunculated colorectal polyps (LNPCPs) represent about 1% of colorectal polyps.
• These polyps carry a risk of submucosal invasive cancer (T1 colorectal cancer).
• Superficial T1 CRC can be curatively resected endoscopically if specific histological criteria are met.

Purpose of the Study:

• To review critical optical evaluation components for predicting T1 CRC risk in LNPCPs.
• To discuss endoscopic resection strategies for LNPCPs.
• To highlight factors influencing the choice of resection modality.

Main Methods:

• Review of optical assessment techniques for LNPCPs.
• Analysis of morphology (Paris, LST classifications).
• Evaluation of surface pit/vascular patterns (JNET, Kudo classifications) and lesion location.

Main Results:

• Optical assessment aids in predicting T1 CRC risk.
• Morphology, surface patterns, and location are key predictive factors.
• Endoscopic resection modalities like endoscopic submucosal dissection and endoscopic mucosal resection are viable options.

Conclusions:

• Thorough optical assessment is imperative for selecting the optimal endoscopic resection strategy for LNPCPs.
• Factors like lesion accessibility and submucosal fibrosis influence resection modality choice.
• Endoscopic resection can achieve curative outcomes for selected LNPCPs with superficial T1 CRC.