Management of colorectal polyps: update and future directions

Endoscopic resection of colorectal polyps is fundamental to colorectal cancer prevention and is a core competency for all colonoscopists. With improved detection through national screening and advances in imaging, endoscopists are increasingly required to manage these lesions effectively. This review provides a structured, evidence-based framework for contemporary colorectal polypectomy, emphasising practical application, lesion assessment and technique selection. High-quality polypectomy begins before the procedure with optimal bowel preparation, equipment readiness and accurate optical evaluation to guide management. Consistent use of validated classification systems facilitates the distinction between benign, dysplastic and invasive lesions, ensuring appropriate referral of complex cases to expert centres. Piecemeal endoscopic mucosal resection remains the mainstay for large non-pedunculated colorectal polyps, with recent refinements significantly improving safety and efficacy. Endoscopic submucosal dissection enables en bloc curative resection of early cancers. Emerging innovations, including endoscopic intermuscular dissection and full-thickness resection, offer potential to extend organ-preserving therapy to increasingly complex and advanced lesions. A tailored approach balancing safety, oncological outcomes, patient-reported outcomes and healthcare resources is advocated.