Resect and Retrieve Colorectal Polyps: Time for New Insights

Polyp retrieval following colorectal polypectomy remains a critical step for histopathological analysis and determining appropriate surveillance intervals. Despite reported retrieval rates exceeding 90% in the literature, significant heterogeneity persists in clinical practice, particularly for polyps <10 mm, due to the lack of standardized retrieval methods. This review synthesizes current evidence on polyp retrieval techniques, the impact of lesion size, and device-specific considerations, including suction-based methods, retrieval nets, and other approaches such as the water-bolus and water-slider techniques. We also examine the clinical utility and limitations of the “resect and discard” and “diagnose and leave in situ” strategies, highlighting barriers to widespread implementation such as medico-legal risks, variability in optical diagnosis, and discrepancies across international guidelines. The integration of advanced imaging technologies, including high-definition endoscopy, virtual chromoendoscopy, and artificial intelligence-driven computer-aided diagnosis (CADx), represent promising tools to help in increasing the diagnostic accuracy of diminutive polyps. As post-polypectomy surveillance recommendations remain tethered to histological findings, this review underlines the need for updated, evidence-based frameworks that take into account technological advancements while ensuring diagnostic precision, cost-effectiveness, and patient safety in colorectal cancer prevention.