A 42-year-old woman presents with 8 months of mucoid diarrhea mixed with bright red blood, tenesmus, and 5 kg weight loss. Colonoscopy reveals multiple sessile and pedunculated erythematous polyps (5–30 mm) with adherent whitish fibrinopurulent caps clustered at mucosal fold apices in the rectosigmoid. Biopsies confirm cap polyposis with hyperplastic crypts covered by fibrinopurulent exudate, without dysplasia. Conservative management with fiber, osmotic laxatives, biofeedback, and topical mesalamine has failed over 6 months. The patient remains symptomatic with persistent bleeding and diarrhea. Which of the following interventions, marked as **A** in the management algorithm, is the preferred next step for this refractory case?
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