When a large colorectal lesion is found, the first goal is to estimate whether it is a benign adenoma, a superficial early cancer or a lesion with deeper invasive potential. High-definition imaging and surface/vascular patterns are important.
In suitable lesions, advanced resection methods such as EMR or ESD can preserve the bowel. EMR is widely used for mucosal lesions, while ESD can be valuable in selected large lesions where en-bloc pathology is important.
Deep invasion features, meaningful lymph-node risk or inability to remove a lesion safely can make surgery the better option. “Large polyp equals surgery” and “endoscopy can treat everything” are both oversimplifications.
Pathology after removal is essential to confirm completeness, invasion depth and whether additional treatment is required.
In suitable lesions, advanced resection methods such as EMR or ESD can preserve the bowel. EMR is widely used for mucosal lesions, while ESD can be valuable in selected large lesions where en-bloc pathology is important.
Deep invasion features, meaningful lymph-node risk or inability to remove a lesion safely can make surgery the better option. “Large polyp equals surgery” and “endoscopy can treat everything” are both oversimplifications.
Pathology after removal is essential to confirm completeness, invasion depth and whether additional treatment is required.
