Management of villous adenoma - beyond endoscopic techniques

Polyp’ is a descriptive term for abnormal projection above an epithelial surface and is not a histological diagnosis. Adenoma is a benign neoplasm of glandular origin and is significant because they are cancers in making. Once a polyp is found, it must be removed in total. Attempts at estimating the polyp histology by endoscopic appearance are often incorrect. With recent advances in endoscopic techniques, most of the polyps are removable through endoscopy. However, there remain a few situations depending on location, size of the lesion and endoscopic expertise available, where complete removal of the polyp requires surgical intervention especially so for large sessile adenomas. We are presenting here four cases of villous adenoma requiring surgical intervention each managed differently depending on presentation and overall clinical picture.