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Large Sessile Polyp EMR — RACP Adult Medicine MCQ

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ModerateGastroenterologyLarge Sessile Polyp EMRRACP Adult Medicine

A 50-year-old woman undergoing colonoscopy for iron deficiency has a 20 mm sessile polyp in the caecum. Biopsies show tubulovillous adenoma with low-grade dysplasia. Complete endoscopic excision appears feasible. What is the most appropriate management?

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Correct answer: C — Endoscopic mucosal resection (EMR)

A 20 mm sessile adenomatous polyp (tubulovillous adenoma with LGD) suitable for en-bloc or piecemeal endoscopic excision should be removed by EMR. EMR is the standard technique for sessile polyps 10-20+ mm. Surgical resection is reserved for polyps not amenable to endoscopic removal (e.g., non-lifting sign suggesting submucosal invasion) or biopsy-proven invasive cancer with deep submucosal invasion. Surveillance colonoscopy follows at 6 months (site check) then 3 years.

Reference: GESA – 2024 – Polyp Management; Cancer Council Australia 2024