[Polyps and polyposis--limits of endoscopic therapy. Are we currently overtreating by removing colorectal polyps?]

Today, endoscopic polypectomy is the standard procedure for the diagnosis and treatment of neoplastic polyps of the colon. There is no longer any doubt that the adenoma-(dysplasia)-carcinoma sequence actually holds true. Size, configuration and histology identify the risk for colorectal carcinoma, and endoscopic treatment can be considered a carcinoma-preventive measure. Even in the case of invasive carcinoma developing in a tubular adenoma, endoscopic polypectomy with a margin of 2 to 3 mm is believed to suffice unless the carcinoma involved is undifferentiated and has invaded blood vessels. In the case of polyposis coli, endoscopic polypectomy serves to establish an accurate classification of the polyposis, however, mass polypectomy must be rejected. In adenomatosis coli colectomy with pouch-anal anastomosis is the treatment of choice.