Endoscopic approach to the large non-pedunculated colorectal polyp: mucosal, submucosal, hot and cold techniques

Large non-pedunculated colorectal polyps represent a heterogeneous group of lesions with variable malignant potential and technical complexity. Appropriate management requires careful lesion assessment, estimation of malignant risk and adoption of selective resection strategy with consideration to the patient, the lesion and technical challenges that may be encountered. Advances in endoscopic resection has meant that most colorectal polyps can be safely removed with an expanding role in the management of early colorectal cancer. Inappropriate lesion assessment and premature surgical referral continue to result in avoidable surgery and its associated morbidity. This review summarises the current evidence on techniques for the management of large non-pedunculated colorectal polyps, highlighting areas of uncertainty and priorities for future research.