Comments on: “Effect of pre-resection biopsy on detection of advanced dysplasia in large nonpedunculated colorectal polyps undergoing endoscopic mucosal resection”

We read with interest the study by Ma et al. [1]. In this retrospective study, the authors demonstrated that pre-resection biopsy (PRB) of large nonpedunculated colorectal polyps (LNPCPs, ≥ 20 mm) did not reliably detect advanced histology and may have affected EMR complexity. Considering the results of the present study, the authors support the recommendation of not performing biopsy of LNPCPs unless there is clear endoscopic suspicion of cancer.

Unfortunately, in this study, the authors did not specify why PRB was performed, which is usually noted in colonoscopy reports. The most common reason for performing PRB in daily practice is to diagnose cancer by biopsy before resection when there is no clear endoscopic evidence of cancer or to confirm malignancy when it would require en bloc resection, which depending on the availability of endoscopic services, may preclude endoscopic resection.

Therefore, PRB might lead to referral bias in the current study. If data are available for patients in this study, we believe it would be interesting to indicate how often cancer was identified by PRB of LNPCPs in the absence of clear endoscopic evidence of cancer. It would also be of interest to ascertain what proportion of cases was upstaged to high grade dysplasia versus cancer from biopsy staging, which would clarify whether PRB may remain useful in not only confirming but also excluding cancer prior to deciding on both the modality of resection and its intended goals.

Publication History

Article published online:
27 September 2023

• Reference

• 1 Ma MX, Tate DJ, Sidhu M. et al. Effect of pre-resection biopsy on detection of advanced dysplasia in large nonpedunculated colorectal polyps undergoing endoscopic mucosal resection. Endoscopy 2023; 55: 267-273