Table 3.

Large colonic polyps or lesions section, key points

• Meticulous evaluation of the morphology (Paris classification), pitt-pattern (Kudo classification) and vascular pattern (NICE classification) dictates indications and type of treatment choice for large (≥10 mm) colorectal lesions.

• Endoscopic mucosal resection is effective in removing en-bloc lesions of 10–20 mm, and piecemeal lesions >20 mm, avoiding surgery in over 90% of patients. Piecemeal resection is associated with high adenoma recurrence rates (25% of cases), easily treated with other endoscopic mucosal resection sessions.

• Endoscopic submucosal resection is technically demanding, but has high en-bloc removal and low recurrence, rates (≥90% and ≤2% respectively).

• Endoscopic mucosal resection and endoscopic submucosal resection have an overall similar colon-preserving efficacy.