Polypectomy

Overview

A polypectomy is a medical procedure aimed at removing a polyp, which is a growth located within an organ or body cavity. These growths can be either cancerous or noncancerous (benign). Although most polyps are usually benign, determining their nature can be difficult for your doctor until the polyp is removed. Certain polyps are considered “precancerous,” indicating that they are currently noncancerous but have the potential to develop into cancer in the future.

Reasons for undergoing the procedure

The necessity for a polypectomy may arise if the polyp:

• Manifests symptoms or complications.
• Displays characteristics suggestive of being precancerous or cancerous.
• Requires laboratory examination.

Many doctors advocate for the removal of all polyps as a preventive measure. Even seemingly noncancerous or asymptomatic polyps can undergo growth and alterations, potentially posing issues later on.

A polypectomy might be recommended for polyps located in hollow organs, such as:

• Stomach polyps.
• Gallbladder polyps.
• Colon polyps.
• Uterine polyps.

The removal and examination of these polyps are crucial for screening and preventing:

• Stomach cancer.
• Gallbladder cancer.
• Colorectal cancer.
• Cervical cancer.

Additionally, polyps may require removal if they result in issues, such as:

• Uncontrolled bleeding.
• Menstruation and fertility problems in the uterus.
• Pain or pressure on organs.
• Obstruction of a blood vessel, bile duct, or intestines.

Risks

Complications are uncommon but may include:

• Infection
• Bleeding
• Puncture or tear in the organ, leading to a leak
• Transmural burn from the electrocautery device
• Intense abdominal pain or pronounced bloating
• Vomiting
• Irregular heart rate

Before the procedure

• Preparation:

Preparation for a polypectomy varies, but if a colonoscopy is scheduled to detect or remove colon polyps, it’s crucial to clear the bowels beforehand. Your healthcare provider will prescribe a bowel prep formula to help empty your bowels before the procedure. Each formula comes with specific instructions, often involving following a special diet in the days leading up to the procedure. The colonoscopy prep usually lasts up to 24 hours.

• Medication:

Your anesthesiologist will engage in a pre-procedure discussion regarding pain management options. The administration of sedatives or anesthesia will be through an intravenous (IV) line to prepare you for the procedure. Additionally, you may be given oral medications to take before or after the procedure, and you may also be advised to refrain from taking certain medications on the day of the procedure.

During the procedure

A simple polypectomy is an endoscopic procedure, utilizing a specialized instrument called an endoscope. This device is a long, flexible tube fitted with a camera and light. Different types of endoscopes are designed for entry into various body canals. For example, a colonoscopy uses a colonoscope to examine the large intestine, while a hysteroscopy employs a hysteroscope to inspect the uterus.

Your doctor will insert the endoscope through your anus, cervix, or down your throat to reach the targeted organ. The camera attached to the endoscope will transmit images to a screen, allowing your provider to locate the polyp accurately. Additionally, carbon dioxide gas may be introduced through the endoscope to expand the organ, improving visibility. Small instruments will be passed through the scope to extract the polyp. Surgical forceps may be used to grasp the polyp or a wire snare to scrape it off. These instruments may be either frozen or heated to immobilize the polyp. The selection of tools and techniques depends on the type and location of the polyp. The polyp will be retrieved in the same manner as the endoscope insertion.

During the procedure, the polyp is removed at its base or stalk without incising the surrounding tissue, potentially leaving behind a small amount of polyp tissue. Your doctor will utilize an electrocautery device—a tool that administers an electric current—to burn away any remaining tissue. This not only ensures complete removal of the polyp to prevent its recurrence but also aids in cauterizing the wound and averting bleeding.

Some polyps present challenges for removal through a standard polypectomy procedure due to factors like their flat shape, large size, or location in a difficult-to-access area. In certain cases, the presence of invasive cancer necessitates an alternative approach to ensure complete removal of the polyp and any associated cancerous tissue.

Alternative approaches for polyp removal include:

• Laparoscopic surgery: If accessing a polyp requires abdominal incisions, surgeons opt for minimally invasive laparoscopic techniques. This method involves small keyhole incisions, typically around half an inch in size, through which a laparoscope and surgical instruments are inserted.
• Endoscopic mucosal resection (EMR): Similar to a standard polypectomy, EMR employs a snare to capture the polyp. However, it involves cutting beneath the polyp into the underlying mucosa. Additionally, a saline solution may be injected into the mucosa beneath the polyp to facilitate lifting for easier access.
• Endoscopic submucosal dissection (ESD): Particularly for large or suspected cancerous polyps, ESD may be necessary. ESD utilizes an electrosurgical cutting device to cut into the deeper submucosal layer beneath the polyp. This enables the removal of larger polyps in one piece, ensuring complete extraction without leaving any residual tissue.

After the procedure

You should be able to head home shortly after the procedure, but it’s advisable to have someone drive you, given the potential lingering effects of anesthesia, such as unsteadiness or lack of focus. You might experience mild discomfort due to residual gas from the procedure, which should gradually dissipate. It’s recommended to be gentle on your digestive system in the following days, especially if it was impacted.

Your doctor will send the removed polyps to the lab for analysis, with results typically available within one to two weeks. Most polyps are noncancerous, but if any evidence of cancer is detected, your provider will schedule further tests and treatments. Even if the polyp is benign, periodic testing may be recommended to monitor for the appearance of additional polyps, as they tend to recur.

Outcome

Recovery is usually quick, often lasting only a few days. You may require prescription or over-the-counter pain medications for a day or two. It’s common to notice minor bleeding in your stool or urine, depending on the site from which the polyp was removed. However, if you experience heavy or prolonged bleeding, it’s important to seek advice from your doctor.