title: How to deal with large colorectal polyps: snare, endoscopic mucosal resection, and endoscopic submucosal dissection; resect or refer?
abstract: OBJECTIVE
  The importance of accurate polyp detection and removal is paramount to preventing colon cancer. Resection of large polyps can be challenging to the endoscopist based on their size, shape, or location. Large polyps have the potential of harboring malignancy and a higher risk of complications with resection. Careful assessment of each lesion and meticulous resection using the appropriate tools and techniques is essential.
  
  
  RESULTS
  Over the last 15 years, the development of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) techniques has presented the endoscopist with the opportunity to manage patients with large and flat lesions thereby avoiding the need for surgery. However, these techniques are complex and require extensive knowledge and skill in the use of various devices to resect a lesion completely and manage bleeding and perforation associated with these procedures.
  
  
  CONCLUSIONS
  Large colon polyps manifest as either polypoid or nonpolypoid (flat) lesions. Polypoid lesions, especially those with pedicles, are removed with snare resection, whereas flat lesions may require the use of EMR or ESD. Resection of large polyps (>1 cm) requires additional tools and techniques to ensure safe and complete resection. We will discuss our approach to dealing with large colorectal polyps: snare, EMR, and ESD; resect or refer?
authors.affiliation: Department of Gastroenterology, Hepatology and Nutrition, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Selvi
authors.initials: S
authors.lastname: Thirumurthi
authors.forename: Gottumukkala S
authors.initials: GS
authors.lastname: Raju
mesh_terms: D003111:Colonic Polyps / Q000473:pathology*; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000473:pathology / Q000517:prevention & control*; D004210:Dissection; D055088:Early Detection of Cancer / Q000379:methods*; D016099:Endoscopy, Gastrointestinal; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D011351:Proctoscopy; D012017:Referral and Consultation