Remember

• Most colorectal cancers arise from colonic polyps. Unsurprisingly, polypectomy has been shown to reduce both the expected incidence and mortality of colorectal cancer.
• Large (20 mm or more) colonic polyps are relatively uncommon; over 90% of polyps detected at colonoscopy are 10 mm or less.
• In the past, patients with large polyps were referred for surgical resection because safe and effective endoscopic polypectomy techniques were not available.
• With modern endoscopic techniques virtually any benign polyp can now be safely and completely removed at day-procedure colonoscopy.
• Given the ability to remove even very large colonic polyps endoscopically, the risk of malignancy is the main determinant of whether surgery is required.