Piecemeal polypectomy is an endoscopic technique used to remove polyps from the colon. Polyps are abnormal tissue growths that can develop on the inner lining of the colon. This procedure removes these growths, some of which may develop into cancer over time.
When Piecemeal Polypectomy is Recommended
Piecemeal polypectomy is recommended for larger polyps, especially those over 2 centimeters in diameter. These larger polyps are often flat or sessile, growing directly from the colon wall without a stalk, which makes them challenging to remove in a single piece. Smaller polyps or those with a stalk (pedunculated polyps) are often removed entirely in one go.
A gastroenterologist, a specialist in digestive system diseases, decides to perform a piecemeal polypectomy. This choice depends on the polyp’s size, shape, and location. The technique allows for the removal of larger or more complex polyps that might otherwise require more invasive surgery.
How the Procedure is Performed
Piecemeal polypectomy is performed during a colonoscopy. A colonoscope, a long, flexible tube with a camera, is inserted into the rectum to view the colon. Once the polyp is located, specialized tools passed through the colonoscope remove the growth in multiple fragments.
Endoscopic mucosal resection (EMR) is a common technique. A saline solution is injected beneath the polyp to lift it from the underlying tissue, creating a cushion. This elevation makes the polyp easier and safer to remove.
A thin wire loop, called a snare, is maneuvered around a section of the polyp. Electrocautery (heat) is applied to cut and seal blood vessels, minimizing bleeding. This process repeats until the entire visible polyp is removed, and all fragments are retrieved for examination under a microscope.
Preparing for and Recovering from the Procedure
Before a piecemeal polypectomy, thorough bowel cleansing is required for a clear view of the colon. This involves a specific diet, such as a clear liquid diet, and taking laxatives or enemas for one to two days prior. Patients should discuss all current medications with their doctor, as some, like blood thinners, may need adjustment or temporary cessation.
On the day of the procedure, a sedative or anesthesia is administered for comfort. Patients lie on their side with knees drawn to their chest.
Recovery is quick, with most patients resuming light activity within a day. Mild symptoms like gas, bloating, or cramping are common immediately after and usually resolve within 24 hours. For a few days, a soft, easy-to-digest diet is recommended, and certain foods and beverages like spicy foods, alcohol, and caffeine should be avoided to prevent irritation. Full recovery from more involved procedures can take up to two weeks.
Understanding Outcomes and Follow-Up Care
The goal of a piecemeal polypectomy is complete polyp removal. All removed fragments are sent for pathological analysis to determine if they are benign, precancerous, or cancerous. Complications are rare but can include bleeding or a perforation (hole) in the bowel wall. Patients should contact their doctor immediately if they experience heavy bleeding, severe abdominal pain, fever, or persistent vomiting.
Piecemeal removal carries a higher chance of residual tissue or recurrence compared to polyps removed in one piece. Therefore, follow-up surveillance colonoscopies are recommended. For polyps 20 mm or larger, the initial surveillance colonoscopy is recommended 3 to 6 months after the procedure, followed by another at approximately one year. Subsequent surveillance is recommended every three to five years, or as determined by specific findings and guidelines. This ongoing monitoring ensures any recurrent or new polyps are detected and addressed promptly.