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Most colorectal cancers arise from adenomatous polyps and sessile serrated lesions. Screening colonoscopy and therapeutic polypectomy can potentially reduce colorectal cancer burden by early detection and removal of these polyps, thus decreasing colorectal cancer incidence and mortality. Most endoscopists are skilled in detecting and removing the vast majority of polyps endoscopically during a routine colonoscopy. Polyps can be considered “complex” based on size, location, morphology, underlying scar tissue, which are not amenable to removal by conventional endoscopic polypectomy techniques. They are technically more challenging to resect and carry an increased risk of complications. Most of these polyps were used to be managed by surgical intervention in the past. Rapid advancement in endoscopic resection techniques has led to a decreasing role of surgery in managing these complex polyps. These endoscopic resection techniques do require an expert in the field and advanced equipment to perform the procedure. In this review, we discuss various advanced endoscopic techniques for the management of complex polyps.

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Case reportsterile. The ureteral catheter was removed by cystoscopy 30 days after A 49-year-old, white woman. who complained of umbilical pain, hac. had a laparotomy at another hospital; a retroperitoneal turnour was found and the biopsy showed the turnour to be a .well-diKerentiated leiomyosarcoma .to the left of the umbilicus, An intravenous pyelogram showed that the left ureter was displaced towards the midline with no evidence of obstruction and there was a calcified stone in the left kidney (Fig. I).At operation on 20 December 1978, the retroperitoneal tumour was the inferior mesenteric vessels and cm of the left ureter which was appendix. which was transected at its base and the tip discarded. The lumen of the appendix was washed with saline solution. The appendix with the appendicular artery was transposed towards the left and an isoperistaltic end-to-end anastomosis was performed to the transected ureter, with 5-0 silk, not including the mucosal layer. A ureteral catheter was placed through the transplanted appendix and its lower tip left loose in the bladder. A Penrose drain was placed near the anastomosis. An intravenous pyelogram performed 15 days after the operation showed a small leak in the superior anastomosis which closed spontaneously (Fig. 2). Urinary cultures repeated after the operation were Operation.The Pathological report revealed. 'tWnoUr of 14 X 10 X 8 cm to which a segment of X cm of ureter was attached'. Microscopic diagnosis was 'leiomyosarcoma which did not invade the ureter'.The subsequent intravenous p y e h r a m s showed a perfect ureteral transit without fistula. We were, however, unable to visualize the lumen of the transplanted appendix but, since no ureteral dilation was seen above the anastomosis, we confirmed that the function of the appendiceal graft was good.two nodular metastases in the right lung and several in both lobes of the resectable liver metastases in both lobes. However, at this time, the function of the left ureter is perfect (Fig. 3).Examination was normal apart from a 10cm removed with the aponeurosis ofthe psoas muscle to which it was fixed, adherent to the tumOUr, The defect was reconstructed using the At present, 40 months after the Operation, the patient has developed laparotomy showed nonliver, demonstrated by CT scan. ~i~~~~~iThe substitution of the ureter by the vermiform appendix has been considered a simple and 'elegant' solution (1). The technique has been described by Melinkoff (21, Kuss (31, Soloviov (4) and Couvelaire (5. 6). The appendix is not always available since appendectomies are frequent but, when present, eter from renal pelvis to hludder. Leak of the superior ureterouppendireal anastotnosis.Postoperative introvenous pyelograpliy with a ureteral cath-