Polypectomy (Removing a Polyp)

What is a polypectomy?

Polypectomy is the removal of polyps in the stomach or bowel during endoscopy or colonoscopy.

Polyps are growths that arise from the inner surface of the digestive tract and can grow into the cavity of the bowel. Polyps of the large bowel in particular are very common.

Most polyps are benign at first. But some kinds of polyp can grow over years and turn into cancer. For this reason removing suitable polyps during colonoscopy is one of the most important methods for preventing bowel cancer.

Is a polyp a cancer?

No. Not every polyp is a cancer.

Most polyps are benign. But it is not always possible to establish the nature of a polyp with certainty from its appearance alone.

Some polyps carry the potential to become cancer while in others this risk is very low. The risk varies with:

• The kind of polyp,
• Its size,
• The number,
• Its shape,
• Where it lies,
• And its microscopic features.

For this reason polyps that are removed are generally sent for pathological examination.

Why is a polypectomy done?

A substantial proportion of bowel cancers develop as a result of changes occurring over years in certain polyps.

This process generally takes a long time.

Removing a polyp with the potential to become cancer during colonoscopy, while there is still no cancer, can prevent the disease from arising.

For this reason colonoscopy is not only an examination that detects cancer early; through the removal of suitable polyps it is also a procedure that can prevent cancer from developing.

Consent form

The clinic’s consent form will be signed.

How is a polyp removed?

The method used to remove a polyp is decided according to the size and shape of the polyp and where it lies.

Small polyps

A substantial proportion of small polyps can be removed with a special wire loop passed through the colonoscope — a snare.

Today, for a substantial proportion of small polyps, cold snare polypectomy, carried out without electric current, is preferred.

Larger polyps

Different endoscopic techniques may be needed for larger or broad-based polyps.

According to the features of the polyp, advanced methods may be used, such as:

• Hot snare polypectomy,
• Endoscopic mucosal resection (EMR),
• Endoscopic submucosal dissection (ESD) in particular cases.

It matters that large or technically difficult polyps are assessed in experienced centres and with appropriate endoscopic methods.

Is the bowel cut when a polyp is removed?

No.

Polypectomy is not an open or keyhole operation.

The endoscope is passed into the bowel through the back passage and the polyp is removed from within the bowel using special instruments passed through the colonoscope.

No incision is made in the abdomen.

Most patients can go home the same day.

Is pain felt while the polyp is removed?

The inner surface of the bowel does not perceive the pain of cutting as our skin does. Colonoscopy is also carried out under sedation or anaesthesia in many centres.

For this reason patients generally do not feel the polyp being removed.

There may be temporary wind or bloating afterwards.

What should be attended to before a polypectomy?

Good bowel cleansing matters a great deal, so that polyps can be seen and removed safely.

You should therefore follow the colonoscopy preparation programme you have been given carefully.

Tell your doctor all the medicines you take.

Be sure to tell your doctor before the procedure in particular if you take:

• Aspirin,
• Clopidogrel,
• Warfarin,
• Apixaban,
• Rivaroxaban,
• Dabigatran and similar blood-thinning medicines.

Blood-thinning medicines should not be stopped on your own decision.

Whether the medicine is continued, stopped temporarily, or the timing of the procedure changed, is decided by weighing the risk of bleeding together with the risk of clotting that stopping the medicine could pose.

Can every polyp be removed at the same session?

Not always.

Most polyps seen at colonoscopy can be removed during the same procedure. But some polyps may not be removed straight away if they are:

• Very large,
• Spread over a wide area,
• In a place that is technically difficult to reach,
• Suspected of extending into the deeper layers of the bowel wall.

In that case the doctor may assess the polyp in detail and plan advanced endoscopic treatment or, where needed, surgical treatment.

Seeing a large polyp does not necessarily mean an operation is needed. Today some large polyps that would once have required an operation can be removed by advanced endoscopic methods.

What are the risks of polypectomy?

Polypectomy is generally a safe procedure. Even so, as with all medical interventions, some complications can develop.

The two most important complications are bleeding and a hole in the wall of the bowel (perforation).

Bleeding

Bleeding can occur from the area where the polyp was removed.

Bleeding may be seen during the procedure, and, after certain polypectomy methods in particular, can also appear within days.

The risk of bleeding depends on factors such as the size of the polyp, where it lay, the method used and whether the patient takes blood-thinning medicines.

A substantial proportion of bleeds can be controlled by endoscopic methods.

Perforation

Far less often, an opening may form in the wall of the bowel. This is called perforation.

Some small perforations can be closed endoscopically, while in some situations observation in hospital or surgical treatment may be needed.

The risk may be increased particularly in the removal of large and technically difficult polyps.

Why is a clip placed?

After some polyps are removed, an endoscopic clip may be placed at the polypectomy site.

A clip may be used to:

• Stop bleeding occurring during the procedure,
• Reduce the risk of bleeding developing later in some situations,
• Close a small opening in the wall of the bowel.

A clip is not needed after every polypectomy.

Most clips separate on their own after a while and pass out through the bowel.

What happens to the polyp that is removed?

The polyp is generally taken out of the bowel and sent to the pathology laboratory.

The pathologist examines the polyp under the microscope.

The pathology result can assess:

• What kind of polyp it is,
• Whether it carries the potential to become cancer,
• Whether there are advanced cellular changes,
• In some situations, whether it was removed completely.

This result also matters in deciding when the next colonoscopy should be.

What is an adenoma?

An adenoma is one of the kinds of polyp seen in the large bowel that carries the potential to turn into cancer over time.

But finding an adenoma does not mean you have cancer.

On the contrary, removing an adenoma while there is still no cancer is a preventive procedure.

It is also known today that certain polyps called serrated lesions may play a part in the development of bowel cancer.

For this reason the follow-up interval is decided not merely on the information that “there was a polyp” but on the pathological features of the polyp.

Is a repeat colonoscopy needed after a polyp is removed?

In some patients, yes.

The timing of the next colonoscopy is decided according to:

• The number of polyps,
• Their size,
• Their pathological kind,
• Whether they were removed completely,
• The adequacy of the bowel cleansing,
• And the person’s other risk factors.

For this reason the same follow-up interval is not given to every patient.

The interval for a patient with a few small low-risk polyps, for instance, may not be the same as for a patient with many polyps or polyps carrying advanced features.

The timing of the follow-up colonoscopy should be decided by the doctor after the pathology result has been seen.

What should be attended to after a polypectomy?

After a small, uncomplicated polypectomy most patients can return to daily life within a short time.

But where a large polyp has been removed or an advanced endoscopic procedure carried out, your doctor may give you specific advice about eating, medicines and daily activities.

If sedation or anaesthesia was given, do not drive that day and avoid work requiring attention.

If you take a blood-thinning medicine, be sure to ask your doctor when to restart it.

In which situations should a doctor be seen urgently?

If, after a polypectomy, there develops:

• Heavy or continuing bleeding from the back passage,
• The passing of blood clots,
• Increasing or severe abdominal pain,
• Marked swelling and hardening of the abdomen,
• Fever and shivering,
• Dizziness or fainting,
• Marked weakness,

the centre that carried out the procedure should be contacted, or emergency medical assessment obtained.

Seeing a small amount of blood after a polypectomy may not always mean a serious complication; but heavy, repeated or continuing bleeding should not be regarded as normal.

What is the most important benefit of polypectomy?

The aim of polypectomy is not merely to remove a growth from the bowel.

Finding and removing, in good time, the bowel polyps that carry the potential to become cancer helps prevent colorectal cancer.

For this reason, in a good-quality colonoscopy the aim is not only to see the polyps but to remove the suitable ones safely and as completely as possible.

Polypectomy in brief

Polypectomy is the removal, by special endoscopic methods, of polyps found during endoscopy or colonoscopy.

Most polyps are benign. Even so, because some polyps can turn into cancer over time, removing suitable polyps early plays an important part in preventing bowel cancer.

The pathological examination of the polyp removed, and the follow-up programme your doctor will advise, are an important part of the procedure.

This text has been prepared for general information. The method of polypectomy and the advice given afterwards can vary with the size, the site and the pathological features of the polyp and with the medicines the patient takes. Your doctor’s advice should be followed for your own treatment and follow-up plan.