What is it?

This procedure is used for the removal of polyps, which are protrusions of the mucous membrane of the digestive system with an implantation base with or without a peduncle (pedunculated or sessile polyp), and which can develop both in the stomach-duodenum and in the colon. There are different histological types of polyps: adenomas are benign tumors that with the passage of time and the increase of their size have a risk of malignant evolution, reason why their removal prevents malignant tumor. Some fragments or the entire polyp are subsequently recovered for histological examination.

Endoscopic polypectomy can be subdivided into mucosectomy or endoscopic submucosal dissection, which consist of the removal of the mucosa or submucosa of an area of the gastrointestinal tract that has undetected or broad-based lesions. The lesions may be benign or malignant in the initial phase, not infiltrating the deeper layers of the mucosa, so that removal resolves the pathology definitively.

These procedures allow a macrofragment of material to be retained for both diagnostic and curative purposes.

When is this exam indicated?

Histological examination is fundamental since it allows to diagnose the nature of the polyp and therefore assess whether or not future controls will be necessary. Before removing the polyp, the doctor may take small fragments (biopsies), which will then be sent to pathology for microscopic or histological analysis. In the case of large polyps, it is usually necessary a further check to exclude the presence of cells undergoing transformation (dysplasia) and, if present, to identify their location.

Endoscopic polypectomy is a definitive therapy in most cases, but if there are cells in an advanced stage of transformation (severe dysplasia) at the base of the polyp or in the stalk, surgery is required to remove the affected section of the intestine or stomach.  

How is it performed?

The procedures, generally performed under deep sedation with anesthesia assistance, are carried out through the introduction from the mouth (gastroscopy) or rectum (colonoscopy) of a small flexible tube equipped with a camera at the tip or with lenses (fiber optics) and fitted with its own light. 

There are three types of polyp removal:

  • Polypectomy: the removal of the polyp is done using a special electric scalpel in the shape of a noose that, painlessly, cuts the polyp by burning the base.
  • Mucosectomy: before the operation, to improve the vision and obtain a more accurate definition of the lesion, substances are used that, sprayed on the mucosa, color it. Subsequently, a solution is injected around and below the lesion with a needle that causes the lifting of the formation itself and facilitates its removal. 
  • Submucosal dissection: the procedure is performed using a special instrument that allows the detachment of the mucosa and submucosa from the deeper layers in order to prevent perforation and bleeding; finally, a circumferential incision of the lesion is made and its removal in a single block with the diathermic loop. Large areas can be removed during this procedure.

How to prepare for the procedure

If the polyp is located in the stomach or duodenum, fasting for at least 6 to 8 hours is required. Therefore, if the examination is carried out in the morning, fasting is recommended from the evening before, if it is scheduled in the afternoon, a light breakfast is allowed in the morning.

If, on the other hand, the polypectomy concerns a polyp of the colon, it will be necessary to perform an adequate preparation in order to accurately evaluate the intestine in the absence of feces, just as it happens for colonoscopy. For this reason, the center where you will perform the examination will provide you with adequate explanations about the type of laxative substance to be used and dietary advice.

It is important that you follow the instructions given to you for the intestinal cleaning method.   

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Polypectomy is a safe procedure.It is essential, however, that the patient's blood clotting values are normal. For this reason, the patient is requested to have certain blood tests before the procedure to confirm this. It is also important that the use of medications (anticoagulants, antiplatelets such as aspirin, or anti-inflammatories) that may alter blood clotting be notified to the physician. Following the procedure, feeding can be resumed the day after the procedure.

The incidence of complications of polypectomy is relatively low. The main short-term complications are abdominal pain, bleeding at the site of polyp removal, and perforation, which are more common when large polyps are removed. Both of these complications can be resolved with medical or endoscopic treatment and only in some cases will surgery be necessary. 

As for long-term complications, there is a possibility of bleeding in the seven days following the procedure due to detachment of the eschar created by the procedure, which usually resolves spontaneously.

Other potential risks arise from the use of sedation in elderly patients or those with severe respiratory or cardiac disease.

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