A 55-year-old man undergoes colonoscopy for haematochezia. A 3 cm sessile polyp is found in the rectum 5 cm from the anal verge with Paris classification 0-IIa+IIc morphology. Biopsies show high-grade dysplasia. The MOST appropriate next step is:
- A Repeat surveillance colonoscopy in 1 year
- B Transanal minimally invasive surgery (TAMIS) with full-thickness excision ✓
- C Endoscopic submucosal dissection (ESD)
- D Low anterior resection (LAR) with total mesorectal excision
Explanation
A 0-IIa+IIc (flat with central depression) rectal polyp with HGD in the rectum is at high risk of submucosal invasion and endoscopic en-bloc resection (ESD) may be attempted for histological staging. However, for a lesion 5 cm from the anal verge that cannot be reliably lifted (depressed component), TAMIS with full-thickness excision provides a staged diagnosis and may be curative for T1 disease with favourable pathology. LAR+TME is reserved for confirmed invasive cancer with unfavourable T1 features (poor differentiation, SM3, LVI) or T2+ disease. ESD is favoured in Asian centres but requires significant expertise.
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.