Scarred and complex colorectal polyps: Traditional techniques and emerging alternatives

Colorectal polyps remain a significant health concern because they can develop into cancer. Therefore, accurate assessment and diagnosis of polyps, along with appropriate treatment decisions, are crucial in preventing complications or malignant transformation. Some polyps are classified as complex polyps, which means they fail to elevate due to a scar from a previously removed polyp or can be determined by a scoring system like the size/morphology/site/access score, which considers factors like site, morphology, size, and access. Management of complex colorectal polyps involves various options, including endoscopic and surgical approaches. Endoscopic mucosal resection (EMR) may be challenging in scarred polyps, as inadequate lifting can result in incomplete resection or recurrence. As a more advanced alternative, endoscopic submucosal dissection (ESD) is suitable for larger lesions, enabling en-bloc resection even in complex cases with EMR. However, ESD requires expertise and is more time-consuming than EMR, often necessitating hospitalization due to its complexity. Endoscopic full-thickness resection could be a viable alternative for managing scarred polyps. Endoscopic powered resection, either alone or in combination with other modalities, can also be used to achieve less extensive resection. Managing complications during the procedure or post-procedurally is equally important, as bleeding or perforations can be fatal. Careful patient selection based on individual profiles and risk factors, along with the identification of any signs of malignancy, is crucial before treatment to avoid negative post-treatment outcomes.