Polypectomy
Polypectomy, also known as endoscopic polypectomy, is a medical procedure where a protruding growth called a polyp is removed while leaving the underlying tissue intact. This procedure is primarily performed to eliminate polyps that are or may become cancerous, particularly those found in the colon and rectum, though it can also address polyps in the stomach, small intestine, uterus, and even the nose. Typically conducted during diagnostic endoscopic procedures such as colonoscopy or gastroscopy, polypectomy involves careful monitoring of the patient’s condition and the use of sedation to ensure comfort.
Preparation for the procedure may require patients to modify their medication regimen and undergo specific dietary restrictions. During the polypectomy, the physician identifies polyps, documents their characteristics, and can either biopsy, ablate, or excise them. Following the procedure, patients are closely monitored before being sent home, often resuming normal activities the next day. While generally safe, polypectomy does carry some risks, including bleeding and infection. The effectiveness of the procedure can depend on factors such as the size and shape of the polyp, and subsequent histopathologic evaluation is essential for determining the potential for cancer and the need for further treatment.
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Subject Terms
Polypectomy
ALSO KNOWN AS: Endoscopic polypectomy
DEFINITION: Polypectomy is the removal of a protruding growth (polyp), leaving the underlying tissue.
Cancers diagnosed or treated: Cancers of the colon, rectum, small bowel, stomach, uterus, and nose
Why performed: Most polypectomies are performed to remove polyps that are or are likely to become cancerous, thereby controlling or preventing the disease. Such polyps arise most frequently in the colon and rectum; less frequently in the stomach, small intestine, and uterus; and rarely in the nose. Most polypectomies are performed during a diagnostic endoscopic procedure (such as colonoscopy, gastroscopy, hysteroscopy, or sigmoidoscopy). Polyps that cannot be removed with an endoscope, such as polyps that are too large or too numerous, require local excision or major surgery to completely remove the polyp and underlying tissue with a margin of healthy tissue.
Patient preparation: A few days before the procedure, the patient may need to stop certain medications. For gastrointestinal procedures, the patient may need to cleanse the bowel and may not eat or drink after midnight.
Steps of the procedure: Endoscopic procedures are scheduled in an outpatient setting. For the procedure, sensors are placed to monitor the patient’s condition. An intravenous (IV) line is started for fluids and medications. The patient lies on the side, and sedation is given. If the patient has an electronic implant, then special precautions are taken. The appropriate endoscope is inserted through the anus (to examine colonic and rectal polyps), mouth (gastric and small intestinal polyps), or vagina (uterine polyps). The physician slowly withdraws the endoscope, carefully viewing the entire lining. When a polyp is found, its location, size, and appearance are documented. The physician may sample (biopsy), destroy (ablate), or remove (excise and retrieve) the polyp. If the polyp was not totally removed, its location is marked with a small tattoo. All samples and excised tissues are taken to the laboratory for histopathologic evaluation.
After the procedure: The patient’s condition is monitored until they awaken and then the patient may leave, transported by a companion. The next day, the patient resumes normal activities.
Risks: Polypectomy is relatively safe, with a small risk of perforation, bleeding, infection, postpolypectomy coagulation syndrome, or reaction to the sedative.
Advances have been made in polypectomy procedures as the twenty-first century progressed. Video endoscopy systems and Computer-aided Detection (CAD) help doctors locate and remove small polyps. Submucosal lifts have enhanced endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) procedures. Enhanced closure techniques following polyp removal can help to decrease complications.
Results: The completeness of removal varies with the polyp’s size and shape (such as broad or stalked) and the removal technique (such as type of excision, with or without ablation). Histopathologic evaluation determines whether each polyp is or is not likely to become cancerous and, if so, whether all diseased tissue was removed. Additional treatment, follow-up examinations, or both may be recommended.
Bibliography
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