Synopsis
Characterise colorectal polyps accurately, secure complete and safe excision, interpret pathology and procedural quality together, and apply UK post-polypectomy surveillance without unnecessary colonoscopy.
- A polyp is a morphological finding, not a final diagnosis. Management depends on size, site, morphology, optical pattern, histology, number and confidence of complete removal.
- Premalignant colorectal polyps include conventional adenomas and serrated lesions; small distal hyperplastic polyps generally carry different risk from proximal dysplastic serrated disease.
- Suspected deep submucosal invasion should be photographed, described, biopsied selectively and referred for colorectal multidisciplinary planning rather than fragmented piecemeal removal.
Key red flags
Ulceration, induration, convergence, depressed morphology, disrupted vascular pattern or convincing non-lifting raises submucosal cancer and should prevent casual piecemeal resection.
Investigation priorities
Detect synchronous lesions, document caecal completion and bowel preparation, and permit complete optical characterisation and resection.
Management branches
A colorectal polyp is identified during screening or symptomatic investigation.
- Record exact segment, calibrated size, morphology and optical pattern, photograph the lesion and inspect for synchronous disease before choosing treatment.
- Remove a lesion with an evidence-based technique within competence, retrieving tissue and documenting en-bloc versus piecemeal excision and confidence of completeness.
Key medicines
Bowel-cleansing preparationUse the locally selected split-dose regimen with timing matched to the procedure, adjusting formulation and fluid advice for kidney, cardiac and electrolyte risk.
Antithrombotic interruption planAlter aspirin, P2Y12 inhibitor, warfarin or direct oral anticoagulant only using the current BSG and local procedure-risk schedule for the individual's thrombotic indication.