Endoscopic Resection of Large Colorectal Lesions

The colorectal cancer (CRC) is one of the most common tumors in Western countries. It is the most common gastrointestinal tumor and it is estimated that between 5 and 6% of the population will suffer it along their lives. Colorectal cancer is a tumor in which it is possible to perform primary and secondary prevention. Primary prevention consists of all actions aimed to prevent the development of cancer or precancerous lesions, whereas secondary prevention is the detection and removal of these premalignant lesions, avoiding then the development of colorectal cancer (CRC). CRC is a disease with a well-known natural history, fulfilling in most cases the adenomacarcinoma sequence (Figure 1), and its natural history is long enough so it can be interrupted by various diagnostic and therapeutic strategies. In fact, in sporadic CRC, which represents most cases, the time since the appearance of a polyp in a colon without neoplastic disease, the posterior growing and degeneration of the lesion to finally become an invasive cancer, is usually not lower than 10-15 years. We therefore have a long time, enough to detect and remove these lesions, interrupting then the natural history of the disease and preventing the development of CRC; so endoscopic polypectomy is a therapeutic key point in the prevention of colorectal carcinoma. Not all polyps degenerate into cancer and, consequently, not all colonic polyps should be removed. Although we already have endoscopic technology that allows us to accurately differentiate neoplastic from hyperplastic polyps, the standard practice is to remove all polyps. Definitely the result of histological examination of the polyp is which determines the way to approach in the future. The technique for the removal of polyps depends on several factors, such as size, location and morphology of the lesions. We can solve most pedunculated and sessile polyps with a simple polypectomy. Most colonic polyps are small and pedunculated, and its removal becomes relatively easy. When sessile polyps are located in the right colon due to the reduced thickness of the colonic wall in this location, injection of drugs into the submucosa before polypectomy decreases the risk of perforation. In large pedunculated polyps with thick pedicles, it can be helpful to use techniques to prevent bleeding after colonic polypectomy. Submucosal adrenaline injection at the base of the polyp or the placement of endoloop or hemostatic clips on the pedicle can prevent the development of bleeding complications. But this is not the aim of this work. Then we would