A polypectomy is the minimally invasive removal of a polyp, an abnormal tissue growth, most frequently performed in the gastrointestinal tract, particularly the colon. Polyps are discovered during an endoscopy, which uses a long, flexible tube equipped with a light and a camera. This allows a specialist to visualize the internal lining of an organ and perform minor operations without a large surgical incision. The entire process of finding and removing the growth is often completed in a single session, making it a highly efficient method of preventive care.
Why Polypectomies Are Performed
The primary justification for polypectomy is the prevention of cancer, especially colorectal cancer. Over 95% of these cancers develop from an adenomatous polyp, following the slow adenoma-carcinoma sequence. This sequence describes how a normal cell develops into a benign adenoma and, over many years, can acquire mutations that lead to malignancy.
By removing the polyp before it can become cancerous, the polypectomy effectively interrupts this disease progression. While many polyps are benign and pose little threat, the physician cannot determine the potential for malignancy without removing the tissue for laboratory analysis. The removal of all potential adenomas is therefore considered a powerful method of secondary prevention.
Polyps may also be removed if they are causing symptoms, though this is less common than removal for cancer prevention. Larger growths can sometimes cause complications such as abdominal pain, rectal bleeding, or a change in bowel habits. In these symptomatic cases, the physical removal of the polyp resolves the immediate health issue while also eliminating any risk of future malignant transformation.
How the Procedure Is Performed
Polypectomy is typically performed during an endoscopic procedure, such as a colonoscopy for polyps in the large intestine. The endoscope, which contains working channels, is guided to the growth using the video feed displayed on a monitor. To improve visibility, the endoscopist may inflate the organ by pumping carbon dioxide gas through the scope.
The method of removal is chosen based on the polyp’s size, shape, and attachment to the organ wall. Small polyps, often those less than 5 millimeters, are generally removed using cold forceps or a cold snare polypectomy technique. A cold snare is a thin wire loop that is closed around the base of the polyp to mechanically detach it from the mucosal lining.
For larger polyps, particularly those with a stalk-like structure (pedunculated polyps), a technique called hot snare polypectomy is preferred. This method uses a wire loop that delivers an electrical current (electrocautery) as it closes around the stalk. The electrical current cuts through the tissue and coagulates the blood vessels at the site to prevent bleeding.
Flatter, broader polyps (sessile polyps) that are 10 millimeters or larger may require a more advanced technique, such as Endoscopic Mucosal Resection (EMR). In EMR, a solution, often saline, is injected beneath the polyp to lift it away from the deeper muscle layer of the organ wall. This creates a protective cushion, allowing the specialist to safely remove the growth in one or multiple pieces with a snare, thereby reducing the risk of perforating the organ.
Preparing for the Procedure and Recovery
Preparation for a polypectomy depends heavily on the location of the polyp, with colon polypectomy requiring the most extensive pre-procedure steps. Patients undergoing a colonoscopy must complete a thorough bowel preparation for clear visualization. This involves following a restricted diet for a day or two and consuming a prescribed laxative solution to empty the bowels.
For any endoscopic procedure that involves sedation or anesthesia, patients must fast, typically for six to twelve hours before the appointment. Fasting prevents the aspiration of stomach contents into the lungs while protective reflexes are suppressed by medication. Patients must also arrange for a responsible adult to drive them home due to the lingering effects of the sedation.
Recovery is generally quick, with most patients being monitored for one to two hours before discharge on the same day. Immediate post-procedure symptoms can include mild cramping and gas, which result from the air or gas used to inflate the organ during the examination. Patients are usually advised to rest and avoid strenuous physical activity for the first 24 hours.
Dietary restrictions are eased quickly, but a soft, easy-to-digest diet may be recommended for the first day. Patients must avoid non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, for up to two weeks unless directed by a physician. These medications increase the risk of delayed bleeding from the removal site.
Understanding the Pathology Results
After the polypectomy, the removed tissue is sent to a pathology laboratory for microscopic analysis. The pathologist determines the precise type of polyp, the presence and degree of abnormal cell changes (dysplasia), and whether the tissue margins are clear. The classification of the polyp, such as tubular, villous, or hyperplastic adenoma, dictates the patient’s future risk profile.
The degree of dysplasia is a measure of how abnormal the cells appear, ranging from low-grade to high-grade, with high-grade indicating a higher potential for developing into cancer. If the pathologist finds invasive cancer within the polyp, they will also check if the cancer cells have extended into the resection margin, which helps determine if further intervention is necessary.
The final pathology report is the most significant factor in determining the schedule for future surveillance colonoscopies. Patients found to have low-risk adenomas, such as one or two small tubular adenomas, may be recommended for a repeat screening in five to ten years. Conversely, the discovery of high-risk adenomas, defined by a size greater than 10 millimeters, the presence of high-grade dysplasia, or villous features, generally shortens the surveillance interval to three years to ensure prompt detection and removal of any new growths.