Endoscopic Recognition and Resection of Malignant Colorectal Polyps

Colorectal cancer is the third most common cancer in the United States and the second leading cause of cancer-related death. Colonoscopy with polypectomy reduces the incidence and mortality of colorectal cancer, and with the growing number of advanced endoscopic resection techniques, select malignant polyps can now be managed endoscopically. Optimal management of malignant colorectal polyps involves careful assessment of the polyp based on morphologic and surface features to determine the risk of submucosal invasion. Lesions with features of deep submucosal invasion typically require surgical resection, although in the absence of these features, superficially invasive lesions are often amenable to endoscopic resection with techniques such as endoscopic mucosal resection, endoscopic submucosal dissection, and, more recently, endoscopic full-thickness resection. These resection techniques should be performed by endoscopists trained in advanced resection modalities.