# A staged approach to resecting a large rectal polyp using endoscopic mucosal resection and trans-anal endoscopic microsurgery: a case report

## TL;DR

A 62-year-old woman with a large rectal polyp was successfully treated using a staged minimally invasive surgical approach, preserving the organ and avoiding full proctectomy.

## Contribution

The paper presents a successful case of staged resection using endoscopic mucosal resection and trans-anal endoscopic microsurgery for a large rectal polyp.

## Key findings

- A 60 mm rectal polyp was resected in two stages using endoscopic mucosal resection and trans-anal endoscopic microsurgery.
- Pathology confirmed complete removal with negative margins and no recurrence at 6-month follow-up.
- The approach was minimally invasive and organ-preserving, avoiding the need for proctectomy.

## Abstract

Large rectal adenomatous polyps are not uncommon. Proctectomy sparing interventions are favored when feasible. We present a case of a 62-year-old woman, who presented with diarrhea for several years. Colonoscopy revealed a very large 60 mm rectal polyp, biopsied as tubulovillous adenoma. This was successfully resected using a staged approach with endoscopic mucosal resection and trans-anal endoscopic microsurgery. Endoscopic mucosal resection removed 70% of the lesion with central scarred not amenable to resection but amenable to transanal excision. Pathology demonstrated tubulovillous adenoma with negative margins. Flexible sigmoidoscopy at 6-month follow-up revealed well healed scar without recurrence or residual disease. This demonstrates a staged resection for a large rectal polyp which is minimally invasive and organ preserving.