Which types of colon polyps can be resected endoscopically?The opinion of Prof. Peter V. Draganov suggests that this question should be based on the fact that all colon polyps have the possibility of endoscopic resection. Currently most colon polyps can be removed endoscopically by biopsy forceps or ligation. With the widespread use of endoscopic mucosal resection (EMR) and endoscopic mucosal dissection (ESD), the range of colon polyps successfully treated endoscopically continues to expand. However, there are still some colon lesions that cannot be treated endoscopically. Medical Pulse has compiled the following list of factors to consider when choosing endoscopic treatment for colon lesions: Lesion-Related Factors For tipped polyps with intramucosal carcinoma, they can be treated with standard ligature ligation. Typically, a definitive diagnosis of intramucosal carcinoma is obtained by pathology sent for examination after polyp removal, and a negative cut margin of the specimen is usually considered a cured colon polyp. However, to ensure negative margins, endoscopic electrosurgery is usually attempted at the midline of the polyp tip, but it is important to ensure that the colonic wall is not damaged. Polyps with high or low grade atypical hyperplasia: As a rule, all conventional or serrated polyps (with or without atypical hyperplasia) are the main type of treatment for endoscopic resection. Colon polyps with intramucosal carcinoma or superficial submucosal invasive carcinoma. Histologically sessile or flat lesions with intramucosal carcinoma or superficial submucosal invasive carcinoma should be treated with ESD. Choosing endoscopic treatment for this type of lesion is a very challenging task because the endoscopist has to assess the depth of lesion infiltration by a large number of relevant and complex criteria, such as polyp morphology (e.g. Paris staging) and endoscopic narrow-band imaging techniques (e.g. NICE staging). Importantly, magnification endoscopy is not available in the United States and the use of stained endoscopy is very limited. Therefore, in the West, a pathologic biopsy is usually required prior to planning ESD treatment. The pathologic biopsy area should be selected to target locations where the cancer is likely to be invasive, such as areas of vascular disorganization and the presence of large lesion nodes. Morphology and size of the lesion Tipped polyps, regardless of size, should be treated with loop ligation. For non-tipped polyps <20 mm in diameter, complete resection is recommended as a priority, or saline-assisted fractionated mucosal resection can be performed. For lateralized developmental colonic granular tumors (LST-G) between 20 and 30 mm in diameter, fractional mucosal resection is usually the treatment of choice. For lateralized developmental non-granular tumors (LST-NG) >20 mm in diameter or LST-G >30 mm in diameter, ESD should be the treatment of choice. If ESD is not feasible, a fractional mucosal resection is also an option, but the recurrence rate of the latter has been reported to be 20 to 40% within one year. Ultrasound endoscopy (EUS): There is no conclusive evidence as to the value of ultrasound endoscopy in the evaluation of lesions. The main factors limiting the use of EUS are that the device is not currently widely available, the high cost of frequent use of microprobes and the low spatial resolution of EUS, which can only distinguish between lesions confined to the mucosal layer or with submucosal infiltration. Endoscopic management: For the following cases, where pathologic biopsy findings are aggressive, where collar treatment is only partially ligated, where EMR does not allow complete resection, where stain is injected beneath the lesion, and where recurrent lesions are associated with fibrosis, EMR techniques usually do not allow complete resection and ESD treatment is recommended. Relevant theoretical and professional skills, supported by large equipment and medical institution, endoscopist specialist: The relevant theoretical knowledge and expertise that an endoscopist should have should include proficiency in endoscopic operating techniques and knowledge of management of postoperative complications. Successful EMR and ESD operations depend on a well-trained, coordinated and cooperative endoscopic team. An essential requirement for a successful endoscopic procedure is a complete equipment package, including EME and ESD resection equipment (e.g., a complete set of collars and ESD knives), stained endoscopic tools, injection tools, ancillary equipment (e.g., titanium clips), and lenses. Preparation for surgical treatment is recommended for lesions with a high risk of combined complications. Referral to a high-level mucosal resection technologist may influence the choice of treatment decision, whether the patient is undergoing complex mucosal resection or is referred.