A 55-year-old man with high-grade dysplasia detected in a 12 mm flat rectal polyp undergoes endoscopic mucosal resection (EMR). Histology shows piecemeal resection with high-grade dysplasia at the lateral margin. The most appropriate next step is:
- A Immediate low anterior resection
- B Repeat endoscopy with attempt at en bloc resection or endoscopic submucosal dissection ✓
- C Adjuvant radiotherapy to the rectum
- D Surveillance colonoscopy in 12 months only
Correct answer: B. Repeat endoscopy with attempt at en bloc resection or endoscopic submucosal dissection
Explanation
Piecemeal resection of a rectal polyp with high-grade dysplasia and involved lateral margins represents an incomplete resection. The first step before considering surgical resection is a repeat endoscopic assessment, ideally with en bloc resection or ESD (endoscopic submucosal dissection), which allows larger, deeper, oncologically complete resections of flat lesions. Proceeding directly to surgery is premature until endoscopic clearance has been attempted or confirmed technically unfeasible. Surveillance alone would be inappropriate given involved margins.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.