Tawheed A, Hafez MM, Ismail A, Madkour A. Scarred and complex colorectal polyps: Traditional techniques and emerging alternatives. World J Methodol 2025; 15(4): 105305 [DOI: 10.5662/wjm.v15.i4.105305]
Corresponding Author of This Article
Ahmed Tawheed, Endoscopy Unit, Department of Endemic Medicine, Helwan University, Ain Helwan, Cairo 11795, Egypt. ahmed.tawhid@med.helwan.edu.eg
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
Author contributions: Hafez MM writing - original draft; Madkour A contributed to supervision; Tawheed A and Ismail A contributed to writing - review and editing.
Conflict-of-interest statement: All authors declare that they have no competing interests.
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: Ahmed Tawheed, Endoscopy Unit, Department of Endemic Medicine, Helwan University, Ain Helwan, Cairo 11795, Egypt. ahmed.tawhid@med.helwan.edu.eg
Received: January 18, 2025 Revised: April 7, 2025 Accepted: April 24, 2025 Published online: December 20, 2025 Processing time: 199 Days and 4.4 Hours
Abstract
Colorectal polyps remain a significant health concern because they can develop into cancer. Therefore, accurate assessment and diagnosis of polyps, along with appropriate treatment decisions, are crucial in preventing complications or malignant transformation. Some polyps are classified as complex polyps, which means they fail to elevate due to a scar from a previously removed polyp or can be determined by a scoring system like the size/morphology/site/access score, which considers factors like site, morphology, size, and access. Management of complex colorectal polyps involves various options, including endoscopic and surgical approaches. Endoscopic mucosal resection (EMR) may be challenging in scarred polyps, as inadequate lifting can result in incomplete resection or recurrence. As a more advanced alternative, endoscopic submucosal dissection (ESD) is suitable for larger lesions, enabling en-bloc resection even in complex cases with EMR. However, ESD requires expertise and is more time-consuming than EMR, often necessitating hospitalization due to its complexity. Endoscopic full-thickness resection could be a viable alternative for managing scarred polyps. Endoscopic powered resection, either alone or in combination with other modalities, can also be used to achieve less extensive resection. Managing complications during the procedure or post-procedurally is equally important, as bleeding or perforations can be fatal. Careful patient selection based on individual profiles and risk factors, along with the identification of any signs of malignancy, is crucial before treatment to avoid negative post-treatment outcomes.
Core Tip: Scarred and complex colorectal polyps remains a big concern because of fibrosis, technical complexity, and excessive recurrence rates. Traditional endoscopic techniques, which includes endoscopic mucosal resection, can be useless in these instances. Emerging alternatives, inclusive of endoscopic submucosal dissection, endoscopic full-thickness resection, and endoscopic powered resection, offer promising solutions for en-bloc resection and lowering recurrence rates. A multidisciplinary technique, integrating high imaging, and different resection techniques, is vital for optimizing affected person results and minimizing complications.·
