Resection of large or giant adenomas is generally a safe procedure. Although adenoma size and morphology are significant predictors of efficacy and safety, each case should be individually evaluated in a specialist unit for feasibility of endoscopic resection.

Colorectal cancer is the second most common cause of cancer-related death in the Western world. Its development is typically through colorectal adenomas. Colorectal cancer prevalence may be reduced substantially by primary prevention including colonoscopy and polypectomy. Secondary prevention applies to populations that have been diagnosed with colorectal adenomas, and its goal is to prevent the development of additional adenomas. It is accomplished mainly by endoscopic surveillance with polypectomy. Additional measures include chemoprevention, used in selected patients only, and modification of risk factors such as smoking, high body mass index, and poor nutrition. This article reviews the current professional guidelines for endoscopic surveillance and adherence by physicians and patients. Measures to increase surveillance efficacy include standardization of colonoscopy among endoscopists and enhanced endoscopy techniques. This article also reviews evidence for the impact of lifestyle modification. It appears that the endoscopic surveillance protocol is often personalized because of the lack of standardization of baseline colonoscopy, suboptimal adherence to the guidelines, and a deficiency in the guidelines with regard to proper risk stratification.