Optimal Management of Malignant Polyps, From Endoscopic Assessment and Resection to Decisions About Surgery

Douglas K. Rex, Aasma Shaukat, Michael B. Wallace

Research output: Contribution to journalReview articlepeer-review

7 Scopus citations


Colorectal cancer is defined clinically as invasion of dysplastic cells into the submucosa. Lesions with submucosal invasion but without invasion into the muscularis propria are generally called malignant polyps. A stepwise approach produces optimal management of malignant polyps (including polypoid and flat/depressed lesions). The first step is to avoid endoscopic resection of non-pedunculated lesions with endoscopic features that predict deep submucosal invasion. Lesions without such features are candidates for endoscopic resection. The second step is to assess candidates for endoscopic resection for features that predict an increased risk of superficial submucosal invasion. Such lesions should be considered for en bloc endoscopic excision if feasible. The third step is giving patients with endoscopically resected malignant polyps good advice regarding whether to undergo adjuvant therapy, usually surgery. We review the endoscopic and histologic criteria that guide clinicians through these steps.

Original languageEnglish (US)
Pages (from-to)1428-1437
Number of pages10
JournalClinical Gastroenterology and Hepatology
Issue number8
StatePublished - Jan 1 2019
Externally publishedYes

Bibliographical note

Funding Information:
Conflicts of interest These authors declare the following: Douglas K. Rex: Aries/Cosmo, Boston Scientific, Olympus, Braintree-consultant; Boston Scientific, Sebela, Medtronic, EndoAid Ltd, Olympus, Paion, Braintree, Medivators-research support. Michael Wallace: Cosmo/Aries, Lumendi, GI Supply-consultant; ownership interest in EndoQuality Consulting; Olympus, FUJIFILM, Boston Scientific, Medtronic-research grants. The remaining author discloses no conflicts. Funding This work was funded in part by a gift to the Indiana University Foundation in the name of Douglas K. Rex from Scott Schurz of Bloomington, Indiana, and his children.


  • Colon Polyp
  • Colorectal Cancer
  • Malignant Polyps

PubMed: MeSH publication types

  • Journal Article
  • Review
  • Research Support, Non-U.S. Gov't

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