Management of difficult colorectal polyps Review of the Literature

Colorectal cancer remains one of the worldwide leading causes of death. Fortunately, screening programs led to an earlier diagnosis and a subsequent approximately 50% decrease in colorectal cancer mortality. It’s known that the majority of malignant polyps arise from adenomatous polyps. Macroscopically, polyps can be classified by many characteristics that generally try to determine de risk to malignancy. Size, location and morphology can be helpful to do an “optical biopsy” as well as Paris and Kudo Classifications, which are powerful signs that help endoscopists to determine the malignancy potential of each lesion. When resected, polyps have to be completely characterized in terms of: size, grade of dysplasia, margins status, and invasion of submucosa, among others features. Independently of the polypectomy technique applied, the goal is always the same: be as most informative as possible about the resected lesion in order to characterize the polyp in a low or a high risk group. Despite that, sometimes there are polyps of difficult decision and in this case, management can be controversial. This reinforces the need of multidisciplinary approach in order to decide always the best for each patient. We present a literature´s review about management of difficult colorectal polyps, introducing polyp classifications, features of potential malignancy, endoscopic techniques for polypectomy and management of malignant polyps.