Polyps, screening & colon cancer: a free FRCS (Gen Surg) Section 1 question

This is a large non-pedunculated colorectal polyp (20 mm or more) with every feature of a benign lesion: granular surface, no depression and a regular pit pattern. UK guidance is that such lesions are discussed by a complex polyp team and treated endoscopically as first-line, because mucosal resection in expert hands clears over 90% with far less morbidity and mortality than colectomy. Right hemicolectomy for a benign polyp is over-treatment unless endoscopic removal fails or is not feasible. Wedge resection is a second-line combined procedure. Observation leaves a lesion with a substantial risk of progression, and ablation alone gives no histology and incomplete treatment. Reference: Rutter MD et al., BSG/ACPGBI guidelines for the management of large non-pedunculated colorectal polyps, Gut 2015.