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Authors’ response — Delineating a rectum-specific selective resection algorithm: the time is now!
  1. Neal Shahidi1,2,3,
  2. Sergei Vosko2,
  3. Michael J Bourke2,3
  1. 1 Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  2. 2 Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
  3. 3 Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Dr Neal Shahidi, Department of Medicine, University of British Columbia, BC V6T 1Z4, Canada; nealshahidi{at}

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We thank Dr Santos-Antunes and colleagues for their important letter on resection technique selection for large (≥ 20mm) non-pedunculated colorectal polyps (LNPCPs) in the rectum.1 2 In response, we would like to address a number of critical points.

Santos-Antunes and colleagues correctly point out that a selective resection algorithm, whereby the majority of lesions are treated by endosocpic mucosal resection (EMR), is the optimal management strategy. This is due to EMR’s effectiveness, efficiency, safety and cost savings compared with endoscopic submucosal dissection (ESD) and surgery.3–5 We also agree that the rectum should be viewed as a separate organ, and requires a rectum-specific resection algorithm. This is due to the twofold increased risk of cancer in rectal LNPCPs, and the heightened risk of morbidity and permanent ostomy formation associated with distal colorectal surgery.6 The authors advocate for a universal ESD strategy for the rectum based on their experience. …

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  • Contributors Drafting of the article was done by NS. Critical revision of the article for important intellectual content was performed by SV and MJB. Final approval of the article was given by MJB.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests NS and SV have no conflicts of interest. Research support was provided by Olympus Medical, Cook Medical, Boston Scientific to MJB.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

  • Provenance and peer review Not commissioned; internally peer reviewed.