A 65-year-old man undergoes colonoscopy and snare polypectomy for a 2 cm pedunculated sigmoid polyp. Histology shows a well-differentiated adenocarcinoma invading the submucosa (sm1) with a 2 mm clear margin and no lymphovascular invasion. What is the next step in management?

• A Surveillance colonoscopy in 3-6 months ✓
• B Adjuvant chemotherapy
• C Surgical resection with lymph node dissection
• D Endoscopic mucosal resection (EMR) of the polypectomy site

Explanation

For malignant pedunculated polyps, endoscopic polypectomy alone is curative if the histology shows favorable features: clear margins (≥2 mm), well or moderate differentiation, no lymphovascular invasion, and invasion limited to the superficial submucosa (sm1). In this scenario, the risk of lymph node metastasis is negligible, and surgical resection is not required. Close endoscopic surveillance is recommended.

Reference: Gastrointestinal Endoscopy, Current Clinical Guidelines ed.

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Written and medically reviewed by the StethoPrep medical team.