Tsagkournis, OrestisBasford, PeterTholoor, ShareefBhandari, PradeepThere is no standardized definition of difficult polyps. However, polyps become difficult and challenging to remove endoscopically when they are large in size, flat in nature, situated in a high-risk location and when access to them is very awkward. Recently, an SMSA (Size, Morphology, Site, Access) classification has been proposed that helps to qualify the degree of difficulty by scoring on the above parameters. This article reviews the features that make polyps difficult to remove and provides some practical tips in managing these difficult polyps. We believe that ‘difficult polyp' is a relative term and each endoscopist should define their own level of difficulty and what they would be able to handle safely. However, in expert trained hands, most difficult polyps can be safely removed by an endoscopic approach.Keywords Colonic polyp, polypectomy, complications, colonoscopy, EMRtext/htmlapplication/pdfimage/bmphttp://www.annalsgastro.gr/index.php/annalsgastro/article/view/1253engHellenic Society of Gastroenterology1792-74631108-7471Annals of Gastroenterology; Volume 26, No 2 (2013); 114Managing difficult polyps: techniques and pitfallsinfo:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersion2013-03-29Δημοσίευση σε περιοδικόPublication in journalΓαστροεντερολογίαGastroenterologyisi -Gastroenterology & Hepatology covers resources on the anatomy, physiology, biochemistry, and pathology of the digestive system. This category includes specific resources on the prognosis and treatment of digestive diseases; stomach ulcers; metabolic, genetic, infectious and chemically induced diseases of the liver; colitis; diseases of the pancreas and diseases of the rectum.Επιστημονικό άρθροScientific articleΕλληνική Γαστροεντερολογική ΕταιρίαGreek Aggregator OpenArchives.gr | National Documentation Centre (EKT)other