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World J Gastrointest Endosc. Dec 16, 2021; 13(12): 638-648
Published online Dec 16, 2021. doi: 10.4253/wjge.v13.i12.638
Large polyps: Pearls for the referring and receiving endoscopist
Eric Markarian, Brian M Fung, Mohit Girotra, James H Tabibian
Eric Markarian, Academy of Science and Medicine, Crescenta Valley High School, Los Angeles, CA 91214, United States
Brian M Fung, Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Arizona College of Medicine - Phoenix, Phoenix, AZ 85006, United States
Brian M Fung, Division of Gastroenterology, Banner - University Medical Center Phoenix, Phoenix, AZ 85006, United States
Mohit Girotra, Section of Gastroenterology and Therapeutic Endoscopy, Digestive Health Institute, Swedish Medical Center, Seattle, WA 98104, United States
James H Tabibian, Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA 91342, United States
James H Tabibian, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, United States
Author contributions: Markarian E drafted the initial manuscript; Markarian E, Fung BM and Tabibian JH created the figures; Fung BM and Girotra M provided critical revisions; Tabibian JH provided supervision and critical revisions; all authors approved the submitted manuscript.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: James H Tabibian, FACP, MD, PhD, Associate Professor, Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, 14445 Olive View Drive, 2B-182, Sylmar, CA 91342, United States. jtabibian@dhs.lacounty.gov
Received: August 19, 2021
Peer-review started: August 19, 2021
First decision: September 29, 2021
Revised: October 4, 2021
Accepted: November 25, 2021
Article in press: November 25, 2021
Published online: December 16, 2021
Processing time: 117 Days and 1.4 Hours
Abstract

Polyps are precursors to colorectal cancer, the third most common cancer in the United States. Large polyps, i.e.,, those with a size ≥ 20 mm, are more likely to harbor cancer. Colonic polyps can be removed through various techniques, with the goal to completely resect and prevent colorectal cancer; however, the management of large polyps can be relatively complex and challenging. Such polyps are generally more difficult to remove en bloc with conventional methods, and depending on level of expertise, may consequently be resected piecemeal, leading to an increased rate of incomplete removal and thus polyp recurrence. To effectively manage large polyps, endoscopists should be able to: (1) Evaluate the polyp for characteristics which predict high difficulty of resection or incomplete removal; (2) Determine the optimal resection technique (e.g., snare polypectomy, endoscopic mucosal resection, endoscopic submucosal dissection, etc.); and (3) Recognize when to refer to colleagues with greater expertise. This review covers important considerations in this regard for referring and receiving endoscopists and methods to best manage large colonic polyps.

Keywords: Adenoma; Endoscopic mucosal resection; Endoscopic tattoo; Colorectal cancer; Polypectomy

Core Tip: Large polyps, often defined as ≥ 20 mm in size, are generally more challenging to resect than smaller polyps with regard to both difficulty of complete removal and risk of adverse events. To effectively manage large polyps, endoscopists should be able to evaluate them for characteristics which may increase the difficulty of endoscopic resection, determine the optimal resection technique, and recognize when to refer to colleagues for more advanced approaches. Herein, we review important considerations and methods to best manage large colonic polyps.