April 6, 2022

Do You Need Surgery To Remove Large Colorectal Polyps?

Larger polyps can be difficult to remove, but there are options

colonoscopy finding a polyp

The results of your colonoscopy come back with some … well, big news. You have colorectal polyps — and they’re large. It turns out that some polyps can grow to the size of a person’s thumb.


Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

Sizeable polyps can be tough to remove. Often, these giants can’t be taken out during a colonoscopy. So, what do you do now? And will surgery be necessary?

Colorectal surgeon I. Emre Gorgun, MD, explains your options.

Why larger polyps pose challenges

The concern about a colon polyp being cancerous grows with the size of the polyp, says Dr. Gorgun. Polyps larger than 20 millimeters (mm) have a 10% chance of being cancerous. They need to be taken out and tested.

By comparison, studies show that few smaller polyps measuring less than 5 mm are cancerous.

All colorectal cancers arise from benign, precancerous polyps, so it’s important to remove them before problems grow. Smaller polyps often can be easily removed during a colonoscopy. (That procedure is known as a polypectomy.)

Unfortunately, larger polyps can be difficult to remove because:

  • They have bigger arteries, and removing them may cause substantial bleeding.
  • Removing big polyps could accidentally perforate (pierce or poke a hole in) your colon. The wall of the right colon is thinner than the wall on the left, so removal of right-sided polyps is riskier, notes Dr. Gorgun.
  • Some large polyps are awkwardly positioned or too flat to be easily snared. Others are just too big.

Ways to remove large colon polyps

Given the complications noted above, a polypectomy may not be the best approach for removing larger colon polyps. Here are other options.

Endoscopic submucosal dissection

Endoscopic submucosal dissection (ESD) is an advanced way of doing surgery through the same tube used for a colonoscopy. This technique has been increasingly used over the past decade, says Dr. Gorgun.

Tiny knives cut away the polyp during the procedure, allowing for a more thorough removal. (During a polypectomy, removal is done with a wire loop snare that doesn’t offer the same precision.)

It’s considered a minimally invasive procedure and is typically done on an outpatient basis.

One of the big benefits of ESD? It could prevent you from needing a more aggressive surgery known as a colectomy. (More on that below.)

There have been concerns raised about an increased risk of bleeding following an ESD compared to a polypectomy. But Dr. Gorgun says he believes that the risk may actually be less given the surgeon’s ability to better see blood vessels.


The risk of perforating your bowel is higher with ESD than with polypectomy, however.


Some doctors may refer patients with large polyps for a colectomy, a surgery to remove part or all of their colon. It’s a major abdominal procedure that could lead to a colostomy.

While a colectomy may be needed, make sure to explore your options, advises Dr. Gorgun. (Learn about one patient’s decision-making process in this Cleveland Clinic Quick Case video.)

“Be sure to get a second opinion from a doctor experienced in advanced polypectomy techniques,” Dr. Gorgun advises. “Removing polyps gets trickier as they get bigger, but some doctors may be more comfortable than others removing large polyps.”

Related Articles

mother breastfeeding baby
June 12, 2023
You’ve Had Breast Surgery — Will That Impact Your Ability To Breastfeed?

Severed milk ducts or lost glandular tissue may affect your milk production

colon polyps size and shape
May 31, 2022
How Colon Polyp Size, Shape and Growth Pattern Affect Cancer Risk

Not all polyps turn into cancer, but they should all be removed

Doctor holding a model of a colon with patient
April 4, 2022
How Long Does It Take Colon Cancer To Grow?

It’s a slow-moving process that offers an opportunity for early detection and treatment

Individual wearing headphones and athletic clothing checks a fitness tracker
May 17, 2021
Best Ways to Prepare Yourself for Surgery

Follow these steps to improve your outcome

caregiver speaking with a patient in a doctor's office
December 28, 2020
How to Know If Your Heart Can Handle Non-Cardiac Surgery

Before agreeing to surgery, ask about cardiac risk

man smoking cigarette
August 4, 2020
3 Reasons Why Smoking Before Surgery Isn’t An Option

Smoking before surgery puts you at risk for death and other complications

Surgery for Older Adults: Predicting How You'll Do Afterward
April 17, 2017
Surgery for Older Adults: Predicting How You’ll Do Afterward

People who are frail have a higher risk of complications

Tired cancer patient reading at night
February 27, 2024
The Link Between Insomnia and Cancer Treatment

Medications, tubing and stress can steal away the ZZZs you need

Trending Topics

close up of keto gummies
Do Keto Gummies Work for Weight Loss? Are They Safe?

Research is inconclusive whether or not these supplements are helpful

Person in yellow tshirt and blue jeans relaxing on green couch in living room reading texts on their phone.
Here’s How Many Calories You Naturally Burn in a Day

Your metabolism may torch 1,300 to 2,000 calories daily with no activity

Older person postioned sideways showing dowager hump.
Dowager’s Hump: What It Is and How To Get Rid of It

The hump at the base of your neck may be caused by osteoporosis or poor posture