Polypectomy

What is a polypectomy?

A polypectomy is a medical procedure to remove a polyp, a growth on the inside of one of your organs or body cavities. Polyps can be cancerous or benign (noncancerous). They’re usually benign, but your healthcare provider may not be able to tell until they remove it. Some polyps are “precancerous,” which means they’re not cancerous now, but could turn into cancer in the future.

Why is a polypectomy done?

You may need to have a polyp removed if the polyp:

• Causes symptoms or complications.
• Looks cancerous or precancerous.
• Needs to be examined in the lab.

Many healthcare providers recommend removing all polyps as a preventative measure. Even polyps that don’t appear to be cancerous, precancerous or cause symptoms can continue to grow and change and become problematic later on.

What conditions are treated with polypectomy?

You may need a polypectomy if you have polyps in your hollow organs, such as:

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

Removing and examining these polyps is important for the screening and prevention of:

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

Polyps may also need to be removed if they cause problems, such as:

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

Is a polypectomy a minor surgery?

Yes. A polypectomy is a minimally invasive procedure. Most polypectomies don’t even require cutting into your body to access the polyp. They can usually be managed internally, with medical instruments passed through the natural openings in your body.

Many polyps are removed when they’re discovered during a colonoscopy or endoscopy exam. These exams involve passing a lighted scope down your throat or through your anus and into your organs. Surgeons can perform minor operations through the scope.

In certain, more difficult cases, your surgeon may need to access a polyp through your abdomen. They can do this through minimally invasive surgery methods, such as laparoscopy. That means passing a scope through one small “keyhole incision” and operating through another.

Is a polypectomy painful?

Healthcare providers use different types of anesthesia and pain relievers to make you comfortable during your polypectomy. You may have general anesthesia and sleep through the procedure if you wish, but it’s not necessary unless you’re having surgery.

In most cases, you’ll be awake for the procedure. You’ll have some combination of pain-blocking medication and a sedative to relax you. You might feel vague pressure or pulling when your polyp is being removed, but you shouldn’t feel pain.

What happens before a polypectomy?

• Preparation: Many polypectomies don’t require any special preparation. However, if you’re having a colonoscopy to look for or remove colon polyps, your bowels will need to be clear. Your healthcare provider will recommend a bowel prep formula to help clear out your bowels before the procedure. Each formula comes with its own instructions. Most require a special diet in the days leading up to the procedure. It may take up to 24 hours to complete the colonoscopy prep.
• Medication: Your anesthesiologist will discuss your pain medication options with you in advance. They’ll give you your sedative or anesthesia through an IV in your vein to prepare you for the procedure. You may also have oral medications to take before or after. Your healthcare provider may ask you not to take certain medications on the day of your procedure.

What happens during a polypectomy?

A simple polypectomy is an endoscopic procedure. That means it’s done through some kind of endoscope, which is a long, flexible tube with a lighted camera attached. Different variations are made to enter different body canals. For example, a colonoscopy uses a colonoscope to examine your large intestine, and a hysteroscopy uses a hysteroscope to examine your uterus.

Your healthcare provider will pass the endoscope through your anus or your cervix or down your throat to reach the appropriate organ. The camera will project images onto a screen. Your healthcare provider will use these images to guide the scope to the location of your polyp. They may pump carbon dioxide gas through the endoscope to inflate your organ so they can see it better.

Your healthcare provider will insert small instruments through the scope to remove the polyp. They may use surgical forceps to grasp the polyp or a wire snare to scrape it off. The tools are either frozen or heated to help immobilize the polyp. Different tools and methods are better for removing different types of polyps in different locations. They’ll pull it out the same way they went in.

A simple polypectomy removes the polyp at the base or stalk, without cutting into the surrounding tissue. A small amount of polyp tissue may be left behind as a result. Your healthcare provider will burn it away with an electrocautery device, a tool that carries an electric current. This helps ensure that the polyp won’t return, and also helps cauterize (seal) the wound and prevent it from bleeding.

What if I need a more complex type of polyp resection?

Certain polyps may be difficult to remove with a simple polypectomy, for various reasons. They may be too flat or too big to be grasped with the forceps or snare, or they may be located in an area that’s hard to see well or hard to access without damaging the surrounding tissue. Sometimes, evidence of invasive cancer requires a different approach to remove the polyp and all cancerous tissue with it.

Some alternative approaches include:

• Laparoscopic surgery: In the event that your surgeon needs to cut into your abdomen to access a polyp, they’ll do so using minimally invasive surgery methods. Laparoscopic surgery is done through a few small keyhole incisions about a half inch in size. One is for the laparoscope and the other is for the surgical instruments.
• Endoscopic mucosal resection: An endoscopic mucosal resection (EMR) is similar to a simple polypectomy in that it uses a snare to capture the polyp. The difference is that it cuts below the polyp into the mucosa underneath. To lift the polyp for easier access, a saline solution is injected into the mucosa underneath the polyp.
• Endoscopic submucosal dissection: Especially large or apparently cancerous polyps may require endoscopic submucosal dissection (ESD) to remove. ESD uses an electrosurgical cutting device to cut into the deeper submucosa layer underneath the polyp. This allows larger polyps to be removed in one piece without leaving tissue behind.

What happens after a polypectomy?

You should be able to go home soon afterward, although you may need someone to drive you. You may still be unsteady or unfocused under the effects of anesthesia. You may have leftover gas trapped inside of you from the procedure, which may cause some mild discomfort until it works its way out. You may need to be gentle on your digestive system for the next few days if it was affected.

Your healthcare provider will send your polyps to the lab to analyze. They’ll have the results back in one to two weeks. Most polyps are benign. If they do find evidence of cancer, they’ll schedule follow-up testing and treatments. Even if your polyp is benign, they’ll want to test you again from time to time to see if more polyps appear. They often do.

What are the advantages of this procedure?

Most polyps don’t cause problems and don’t become cancerous, but if they do, early intervention is key. Removing and analyzing the polyp in the lab is the only way to be sure that cancer isn’t present. Healthcare providers can also learn more about the type of polyp it is and whether it’s likely to change. They can plan your future care based on their findings.

What are the risks or complications of this procedure?

Complications are rare, but include:

• Bleeding.
• Infection.
• A puncture or tear in the organ, causing a leak.
• Transmural burn from the electrocautery device.

What is postpolypectomy coagulation syndrome?

Postpolypectomy coagulation syndrome (also known as postpolypectomy syndrome or transmural burn syndrome) is a rare complication that may develop after a polypectomy. It happens when the electrocautery device that was used to burn away the stump of the polyp burns into underlying tissue. Symptoms may include abdominal pain, fever and leukocytosis (high white blood cell count, a sign that your immune system has been activated).

The symptoms of postpolypectomy coagulation syndrome (PPCS) resemble the symptoms of a puncture or tear in the tissues, which would be more serious. A tear would require surgery to repair. But postpolypectomy syndrome is a more benign condition that resolves over a few days with medication. Symptoms usually appear within 12 hours after your procedure, but sometimes, it takes a few days. Be sure to let your healthcare provider know if you have symptoms.

How long does it take to recover from a polypectomy?

Recovery is quick, usually a matter of days. You may be taking prescription or over-the-counter pain medications for a day or two. You may have some light bleeding in your poop or pee, depending on where your polyp was removed. This is normal, but be sure to consult your healthcare provider if you have heavy or persistent bleeding.

A note from Cleveland Clinic

Polyps are very common, especially in certain places like your colon. Many people have them without realizing it. If your healthcare provider discovers a polyp or several during a routine exam, it’s usually nothing to worry about. Depending on the type of exam it is, they might be able to remove any polyps at first sight. If not, they’ll schedule a simple polypectomy.