Pang S, Tavakoli P, Shahidi N. Prevention and treatment of recurrence after endoscopic resection of large non-pedunculated colorectal polyps. World J Gastrointest Endosc 2025; 17(7): 107746 [DOI: 10.4253/wjge.v17.i7.107746]
Corresponding Author of This Article
Neal Shahidi, MD, PhD, Assistant Professor, Department of Medicine, University of British Columbia, 770-1190 Hornby Street, Vancouver V6Z2K5, Canada. nealshahidi@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Jul 16, 2025; 17(7): 107746 Published online Jul 16, 2025. doi: 10.4253/wjge.v17.i7.107746
Prevention and treatment of recurrence after endoscopic resection of large non-pedunculated colorectal polyps
Samantha Pang, Pedram Tavakoli, Neal Shahidi
Samantha Pang, Pedram Tavakoli, Department of Gastroenterology, St. Paul's Hospital, Vancouver V6Z2K5, Canada
Neal Shahidi, Department of Medicine, University of British Columbia, Vancouver V6Z2K5, Canada
Author contributions: Pang S created the manuscript; Tavakoli P and Shahidi N revised the manuscript for important intellectual content; all authors have read and approved the final manuscript.
Conflict-of-interest statement: Shahidi N received a speaker’s honorarium from Pharmascience, Boston Scientific, and Takeda Pharmaceuticals. Pang S and Tavakoli P have no conflict of interests to report.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Neal Shahidi, MD, PhD, Assistant Professor, Department of Medicine, University of British Columbia, 770-1190 Hornby Street, Vancouver V6Z2K5, Canada. nealshahidi@gmail.com
Received: March 30, 2025 Revised: April 17, 2025 Accepted: May 21, 2025 Published online: July 16, 2025 Processing time: 103 Days and 4.3 Hours
Abstract
Minimally invasive endoscopic resection techniques are the recommended first-line treatment strategy for the majority of large non-pedunculated colorectal polyps, with endoscopic mucosal resection (EMR) as a predominant resection modality due to its efficacy, efficiency, safety, and cost-effectiveness. A limitation of EMR is recurrence, which has historically occurred in 15%-20% of lesions. In the past 10 years, a number of effective mitigating strategies have been developed, including margin thermal ablation using snare-tip soft coagulation, argon plasma coagulation (APC), and hybrid-APC, alongside margin marking pre-resection. Moreover, techniques for effective recurrence management have also been developed. Herein, we appraise existing evidence on the frequency of recurrence, reasonings behind recurrence formation, as well as recurrence mitigating strategies and the effectiveness of recurrence management.
Core Tip: Endoscopic resection techniques are the recommended treatment strategy for most large non-pedunculated colorectal polyps, with endoscopic mucosal resection as a predominant resection modality. However, recurrence has historically occurred in 15%-20% of lesions. Margin thermal ablation and pre-resection margin marking can effectively mitigate recurrence. Moreover, effective recurrence management techniques can reduce the need for surgery. Herein, we appraise existing evidence on the frequency of recurrence, reasonings behind recurrence formation, as well as recurrence mitigating and management strategies.
