Polypectomy

Polypectomy is a procedure in which a doctor removes polyps — small growths of extra tissue — from the inside lining of the digestive tract, most often from the colon (large intestine) or the stomach.

During the procedure, a flexible tube called an endoscope is passed through the mouth or the back passage to reach the polyp. The doctor uses a tiny wire loop, a pair of small forceps (grasping tools), or an electrical current to cut the polyp away from the wall of the bowel. The goal is to remove the growth completely before it has a chance to become cancerous or to cause symptoms such as bleeding.

Polypectomy is performed whenever polyps are found during an endoscopic examination, whether they were discovered by chance or because a patient was being investigated for a specific problem. The main reason to remove a polyp is to prevent it from turning into cancer or to stop it from causing harm.

• Adenomatous polyps (polyps made of glandular tissue that have a higher chance of becoming cancerous) found during a colonoscopy or gastroscopy
• Hyperplastic polyps (polyps made of fast-growing but usually harmless cells) that are large enough to cause concern
• Serrated polyps (a group of polyps with a saw-tooth pattern under the microscope) that carry some cancer risk
• Rectal bleeding or blood found in a stool test that is traced back to a polyp
• Familial adenomatous polyposis (FAP), an inherited condition where hundreds of polyps grow in the colon
• Lynch syndrome (an inherited condition that raises the risk of colorectal cancer), where regular polyp removal is part of ongoing care
• Polyps in the stomach found during investigation of indigestion, anaemia (low red blood cell count), or unexplained weight loss

Polypectomy is not always suitable for every polyp. Your doctor will assess the polyp carefully before deciding.

• Very large polyps that have grown deep into the bowel wall may need open or laparoscopic (keyhole) surgery instead
• Polyps that already show signs of invasive cancer may require a more extensive surgical operation
• Patients who cannot safely stop blood-thinning medications before the procedure may need a different approach or timing
• Patients who are too unwell to tolerate sedation or the procedure itself may not be suitable candidates at that time

Polypectomy is generally considered a safe procedure, but like any intervention inside the body, it carries some recognised risks that patients should be aware of.

• Bleeding at the site where the polyp was removed — this is the most common complication and can sometimes occur days after the procedure; it usually stops on its own or can be treated through the endoscope
• Perforation (a small tear or hole in the bowel wall) — rare, but may require surgery to repair if it occurs
• Post-polypectomy syndrome (abdominal pain and fever caused by localised irritation of the bowel wall after electrical removal) — usually managed without surgery
• Incomplete removal, meaning a small piece of the polyp is left behind and may need a repeat procedure
• Reactions to sedation (the medication used to keep the patient relaxed and comfortable), such as breathing difficulties or a drop in blood pressure — the endoscopy team monitors for these throughout
• Infection at the removal site — uncommon but possible, particularly with larger polyps
• In very rare cases, aspiration (accidentally breathing in stomach contents) during sedation

Good preparation is essential for a safe and successful polypectomy, because the doctor needs a completely clear view of the bowel lining. Your care team will give you specific written instructions, but the following explains what preparation typically involves.

Before the procedure, patients are usually asked to follow a bowel preparation (laxative) programme for one to two days. This involves drinking a prescribed cleansing solution and following a clear liquid diet to empty the colon completely. For stomach polyps found during a gastroscopy, the preparation is simpler — usually fasting for several hours beforehand. Smoking and alcohol are generally discouraged in the days leading up to the procedure, as both can affect healing and the body's response to sedation. Blood-thinning medications and some anti-inflammatory drugs are typically paused for a period before the procedure, but this is decided by the doctor after reviewing each patient's full medical history.

Tests that are commonly arranged before polypectomy include:

• Blood tests to check clotting (the blood's ability to stop bleeding), kidney function, and blood count
• An electrocardiogram — EKG — (a recording of the heart's electrical activity) if the patient has heart disease or is older
• Review of any previous endoscopy images or biopsy (tissue sample) results to help the doctor plan the approach

On the day of the procedure, a typical sequence of events is:

• 1. The patient arrives and the care team checks identity, consent, and preparation quality.
• 2. A small needle is placed in a vein in the arm to allow sedation or pain-relief medication to be given.
• 3. The patient is positioned on their left side (for colonoscopy) or on their back (for gastroscopy).
• 4. The endoscope is gently guided in through the mouth or anus.
• 5. The doctor advances the endoscope to the location of the polyp, which was identified during a previous examination or is found during the same session.
• 6. The polyp is assessed — its size, shape, and surface pattern help the doctor choose the removal method.
• 7. For small polyps, cold forceps or a cold snare (a wire loop that cuts without electricity) are used. For larger polyps, a hot snare (a wire loop that uses electrical current) or endoscopic submucosal dissection — ESD — (a technique that carefully lifts and separates the polyp from the deeper layers) may be used.
• 8. The removed polyp tissue is collected and sent to a pathology laboratory for examination under a microscope.
• 9. The doctor checks the removal site for bleeding and, if needed, applies clips or electrical coagulation (heat to seal blood vessels) to stop any bleeding.
• 10. The endoscope is carefully withdrawn, and the patient is moved to a recovery area.
• The overall time varies depending on how many polyps are removed and the technique used. Your doctor will give you a realistic estimate beforehand.

After the polypectomy, the patient is monitored in a recovery area until the effects of sedation wear off, which usually takes between thirty minutes and a couple of hours. Most patients who had small polyps removed are discharged home the same day, but patients who had a more complex removal or who experienced a complication may stay in hospital longer. Someone must accompany the patient home and stay with them for the first night, as sedation affects coordination and judgement.

• Diet: Patients are usually advised to eat only light, easy-to-digest food for the rest of the day. A normal diet can typically resume the following day, unless the doctor instructs otherwise.
• Activity: Rest is recommended for the remainder of the procedure day. Strenuous exercise and heavy lifting are usually avoided for a period of about one week after polypectomy, or longer if larger polyps were removed — your doctor will advise.
• Bleeding awareness: Some patients notice a small amount of blood in their stool (faeces) in the first couple of days, which can be normal. However, heavy or persistent rectal bleeding, severe abdominal pain, fever, or vomiting should be reported to the medical team immediately.
• Bowel discomfort: Mild bloating (trapped air in the bowel) and cramping are common in the hours after the procedure and usually settle quickly.
• Blood-thinning medications: The medical team will advise when these can be safely restarted based on the size of the polyp removed and the individual patient's situation.
• Wound care: There is no external wound; the removal site is inside the bowel and heals on its own.
• Pathology results: The tissue removed is examined in a laboratory. Results usually take one to two weeks. The doctor will explain what the findings mean and whether any further treatment is needed.
• Follow-up colonoscopy: The timing of the next colonoscopy depends on the number, size, and type of polyps removed. Some patients are recalled after one year; others after three or five years. Your gastroenterologist (digestive system specialist) will give a personalised schedule.
• Lifestyle: Eating a diet high in fibre, maintaining a healthy body weight, limiting red and processed meat, not smoking, and limiting alcohol are all factors that are generally recommended to reduce the risk of new polyps forming.