Editorial
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 7, 2024; 30(25): 3126-3131
Published online Jul 7, 2024. doi: 10.3748/wjg.v30.i25.3126
Large non-pedunculated colorectal polyp management: The elephant in the room
Shirley X Jiang, Neal Shahidi
Shirley X Jiang, Neal Shahidi, Department of Medicine, University of British Columbia, Vancouver V6Z 2K5, BC, Canada
Author contributions: Jiang SX contributed to drafting of the article; Shahidi N contributed to critical revision of the article for important intellectual content and final approval of the article.
Conflict-of-interest statement: Neal Shahidi received a speaker's honorarium from Pharmacology, Boston Scientific. Shirley X Jiang did not report a conflict of interest.
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: Https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Neal Shahidi, FRCPC, MD, PhD, Assistant Professor, Department of Medicine, University of British Columbia, 770-1190 Hornby Street, Vancouver V6Z 2K5, BC, Canada. nealshahidi@gmail.com
Received: March 3, 2024
Revised: May 19, 2024
Accepted: June 11, 2024
Published online: July 7, 2024
Processing time: 119 Days and 12.2 Hours
Abstract

Minimally invasive innovations have transformed coloproctology. Specific to colorectal cancer (CRC), there has been a shift towards less invasive surgical techniques and use of endoscopic resection as an alternative for low risk T1 CRC. The role of endoscopic resection is however much more extensive: It is now considered the first line management strategy for most large (≥ 20 mm) non-pedunculated colorectal polyps, the majority of which are benign. This is due to the well-established efficacy, safety, and cost-effectiveness of endoscopic techniques compared to surgery. Multiple endoscopic modalities now exist with distinct risk-benefit profiles and their outcomes are further improved by site-specific technical modifications, auxiliary techniques, and adverse event mitigation strategies. Endoscopic capacity continues to evolve with emerging endoscopic techniques and expanding applications, particularly in the confines of a multi-disciplinary setting.

Keywords: Cancer; Colonoscopy; Endoscopy; Polyp; Endoscopic mucosal resection; Endoscopic submucosal dissection

Core Tip: There is a movement towards minimally invasive management of colorectal disease, including the use of less invasive surgical techniques for colorectal cancer. Similarly, a paradigm shift in endoscopic resection has led to the development of a gamut of techniques, which are now first-line management strategies for most large (≥ 20 mm) non-pedunculated colorectal polyps (LNPCPs) - the majority of which are benign. This is due to their proven efficacy, safety and cost-effectiveness compared to surgery. With increasing detection of LNPCPs in universal screening programs, further adoption of an endoscopic approach in the era of minimally invasive resection techniques is anticipated.