Updates in the endoscopic management of colorectal polyps.

Abstract

Endoscopic resection of pre-malignant polyps remains a cornerstone of colorectal cancer prevention. This review provides an evidence-based analysis of the current approaches to endoscopic colorectal polyp management. Cold snare resection is recommended for small and diminutive polyps. Sessile serrated lesions are safely and efficiently removed using cold snare with or without sub-mucosal lift. For large non-pedunculated colorectal polyps (LNPCPs), snare tip soft coagulation of the resection margins reduces recurrence, post-resection clip closure of proximal colon lesions prevents post-endoscopic mucosal resection (EMR) bleeding and early recognition of deep mural injury (DMI) using the Sydney DMI Classification guides intervention and prevents delayed perforation. Cold-forceps avulsion with adjuvant snare tip soft coagulation (CAST) is an effective tool for managing residual or recurrent adenoma. Endoscopic sub-mucosal dissection (ESD) is recommended for selected high-risk LNPCPs based on location and endoscopic optical assessment. This comprehensive review synthesises these points based on current evidence and provides practical guidance for endoscopists, aimed at improving resection of colorectal polyps to enhance patient outcomes and safety.