Gastrointestinal polypectomy

Gastrointestinal polypectomy enables certain polyps to be removed during an endoscopy, particularly in the colon and rectum. The technique is tailored to the size, shape, location and characteristics of each lesion.

What is a gastrointestinal polypectomy?

A polyp is a growth that protrudes from or extends over the inner surface of the digestive tract. It can occur in various locations, including the colon, rectum, stomach or duodenum.

A polypectomy allows the polyp to be removed using instruments that are passed through the endoscope itself. In this way, many lesions can be treated during a colonoscopy or gastroscopy without the need for abdominal surgery.

The removed tissue is usually sent to the Pathology Department, where it is examined under a microscope. This examination helps to determine the type of lesion that has been removed, identify any significant cellular changes and decide what follow-up may be required.

Not all gastrointestinal polyps have the same significance

The term ‘polyp’ primarily describes a visible form and does not, on its own, determine the nature of the lesion. The behaviour and treatment can vary significantly depending on the organ in which it appears and its microscopic characteristics.

In the colon and rectum, some polyps are adenomas or serrated lesions with the potential to progress over time. In the stomach, there are different types of polyps, some of which may require only a biopsy or follow-up, whilst others require complete resection.

Lesions of the duodenum require particularly careful assessment because the anatomy and characteristics of its wall affect both the technique and the risk profile of the procedure.

When might it be advisable to remove a polyp?

Many polyps are discovered during a colonoscopy carried out as part of a screening programme, when the person has no symptoms. Others are found whilst investigating gastrointestinal bleeding, anaemia, persistent changes in bowel habits or other problems.

The decision to perform a polypectomy is based on the characteristics of the lesion found. In the colon and rectum, many lesions with an adenomatous or serrated appearance are removed when this can be done endoscopically and with an appropriate balance of benefit and risk.

The removal of certain precursor lesions forms part of the prevention of colorectal cancer, as it prevents some of them from progressing over time. This does not mean that all polyps would go on to develop into cancer.

In the stomach and duodenum, the indication depends particularly on the probable type of polyp, its size, any previous biopsies where available, and the condition of the surrounding mucosa. Resection may also be considered when a lesion causes bleeding, anaemia, difficulty in the passage of digestive contents, or requires a full histological examination.

When can a polyp be removed during the first endoscopy?

Small, well-defined and technically straightforward polyps can be removed during the same examination in which they are detected.

Large, flat lesions, those situated in complex locations or with characteristics that require a more detailed assessment may need a specifically scheduled session. In these cases, the endoscopist can document the lesion using images, examine its margins and plan the most appropriate technique before attempting resection.

This planning is particularly important for complex lesions. An incomplete resection may lead to scarring and fibrosis, which could subsequently make a complete endoscopic resection more difficult.

How the polypectomy technique is chosen

The decision begins with a detailed assessment of the polyp. The endoscopist examines its size, shape, location, accessibility and surface pattern, as well as any signs that might suggest the lesion extends into deeper layers of the digestive tract wall.

For many small colorectal polyps, cold snare polypectomy can be used. A thin metal loop encircles the lesion, allowing it to be cut without the use of an electric current.

For other lesions, an electrosurgical snare may be used, which allows the lesion to be cut and the tissue to be coagulated in a controlled manner. The choice does not depend solely on the diameter of the polyp: its attachment pattern, location and suspected depth also play a role.

Endoscopic resection of large or complex lesions

Some flat or larger lesions require advanced therapeutic endoscopic techniques.

Endoscopic mucosal resection (EMR) enables the treatment of certain large lesions. In many cases, a solution is injected beneath the lesion to separate it from the deeper layers before proceeding with its resection.

An extensive lesion may be removed in several fragments where this approach is appropriate. This allows certain large lesions to be treated endoscopically, although it makes it more difficult to assess the margins fully under the microscope and may necessitate a subsequent review of the scar.

Endoscopic submucosal dissection (ESD) is a more advanced technique that allows certain lesions to be separated in a controlled manner and removed in a single piece. It is reserved for situations where this form of resection offers a clinical advantage.

The choice between conventional polypectomy, EMR, ESD or other strategies depends on the organ, the characteristics of the lesion and the possible depth of invasion.

Preparation before polypectomy

When the resection is carried out during a colonoscopy, adequate bowel preparation is essential to ensure a clear view of the mucosa, to identify any other potential lesions and to perform the procedure with precision.

The centre provides a tailored diet plan and a bowel preparation solution, adapted to the time of the examination and the clinical circumstances. If preparation is insufficient, it may be necessary to postpone the resection or repeat the colonoscopy.

When the procedure is carried out via gastroscopy, the relevant fasting instructions must be followed.

Before any resection, relevant medical conditions, allergies and regular medication are reviewed. Anticoagulant and antiplatelet treatments require an individual assessment of the risk of bleeding and the risk associated with discontinuing them, and should not be altered without medical advice.

How endoscopic polypectomy is performed

At the Publio Cordón Memorial Hospital, polypectomy forms part of the work carried out by the Digestive Endoscopy Unit, which performs diagnostic and therapeutic endoscopy, polyp resection and advanced procedures in digestive medicine.

An endoscope is a flexible tube fitted with a camera and working channels. It is inserted through the mouth when the lesion is located in the upper digestive tract and through the anus when it is in the colon or rectum.

Once the polyp has been located, the specialist examines its surface and delineates its edges. High-definition endoscopic imaging systems help to characterise the lesion and determine how it should be treated. Memorial’s Digestive Endoscopy Unit has the diagnostic and therapeutic capacity to manage polyps and pre-malignant lesions of the digestive tract.

In a conventional polypectomy, the snare is placed around the polyp and tightened to separate it from the mucosa. Depending on the lesion, the cut may be made using a cold knife or a controlled electric current.

In certain resections, fluid may be injected beneath the lesion to elevate it and facilitate working at the correct depth. Once removed, the endoscopist carefully inspects the treated area.

If bleeding occurs during the procedure, it can be treated during the same session using clips, coagulation or other endoscopic techniques. A sample is taken whenever possible for subsequent analysis.

Sedation and sensations during the examination

The level of sedation is tailored to the type of endoscopy, the expected duration and the complexity of the resection. Vital signs are monitored throughout the procedure and, in more complex resections, specific involvement of the Anaesthesia Department may be required.

Sedation is intended to improve comfort. During a colonoscopy, you may experience a sensation of pressure, bloating or discomfort related to the gas and the advancement of the endoscope.

After the examination, you may still experience gas, bloating, mild cramps, a sore throat following a gastroscopy, or tiredness due to the sedation.

What information does histopathology provide?

Microscopic analysis is an essential part of the process. It enables the type of polyp to be identified and determines whether there are any cellular changes that are relevant to follow-up.

One of the terms that may appear is ‘dysplasia’, which describes abnormal changes in the cells. The presence of dysplasia may be associated with a higher risk of progression, but does not in itself equate to invasive cancer.

When the lesion is removed in a single piece, the pathologist can assess certain factors more accurately, such as the resection margins and the depth of the changes. If it has been removed in several fragments, this assessment may be more limited and must be interpreted in conjunction with the information provided by the endoscopist.

In a small proportion of lesions, a focus of cancer may be identified. In such cases, the next step depends on the depth, the margins and other microscopic characteristics, not merely on the fact that tumour cells have been found.

What results can be expected following resection

In the case of many small polyps, polypectomy allows for complete removal during a single endoscopy.

In the colon and rectum, the removal of adenomas and certain serrated lesions forms part of the prevention of colorectal cancer. The procedure removes the existing lesion, although it does not prevent new polyps from appearing in other areas over time.

In the case of large lesions or those removed in fragments, the outcome is determined by combining the endoscopic findings, the pathologist’s report and, where appropriate, a subsequent examination of the scar tissue.

Where a polyp was causing bleeding or anaemia, its removal may help to resolve the problem. Many lesions, however, produce no symptoms and are treated primarily on the basis of their characteristics and their potential future course.

Risks and possible complications depending on the lesion and the technique used

Polypectomy may be associated with complications, but the type and likelihood of these occurring depend on the size and location of the polyp, the technique used, the extent of the resection and the individual’s clinical characteristics.

Bleeding may occur during the endoscopy itself and be treated immediately, but it may also begin hours or days after the procedure. Some situations may require a repeat endoscopy, hospital observation or other treatments.

Another possible complication is perforation, that is, a hole in the wall of the digestive tract. Some perforations can be closed endoscopically if detected early, whilst others may require surgery.

When techniques involving an electric current are used, inflammation of the digestive tract wall may occur without a complete perforation. Furthermore, sedation may be associated with respiratory or cardiovascular disturbances, which are monitored throughout the procedure.

In lesions removed in fragments, a small amount of tissue may remain, or a local recurrence may occur at the scar site. This possibility is managed through endoscopic follow-up.

There is no single risk estimate applicable to all polypectomies. Removing a small polyp using a cold snare and performing an advanced resection of an extensive lesion are clinically distinct procedures.

Recovery following a polypectomy

Many people can return home after a period of recovery and observation. The need to remain in hospital depends on the complexity of the resection, the risk of bleeding, any underlying medical conditions and any complications that may arise.

Where sedation is used, the team’s advice regarding driving, activities requiring concentration and the need to be accompanied should be followed.

Diet and activity are tailored to the type of resection. Recovery following a simple polypectomy is usually different from that required after an extensive endoscopic resection.

Before discharge, the team provides personalised instructions on diet, medication, activity and symptoms that require medical attention.

How is the follow-up after a polypectomy decided?

Follow-up does not depend solely on whether a polyp has been removed. The specialist takes into account the number and size of the lesions, their histological type, the presence of dysplasia, the quality of the endoscopy and the certainty that the resection was complete.

Some people with a few small, low-risk colorectal polyps may only need follow-up at longer intervals or may be able to return to the standard screening programme. Large, numerous lesions, those with advanced changes, or those removed in fragments usually require more frequent follow-up.

Following a piecemeal resection of a large lesion, a specific endoscopy may be scheduled to examine the scar and treat any small residual tissue that may remain.

The recommendations used for colon and rectal polyps do not automatically apply to lesions of the stomach or duodenum, the follow-up of which depends on their nature and the context of the surrounding mucosa.

What happens if some tissue remains or the lesion returns?

If the specialist considers that the resection has not been complete, they may treat the remaining tissue during the same procedure or schedule a further session.

Residual tissue may also be identified during a follow-up examination of the scar. In many cases, it is possible to treat it again using endoscopy.

Where the location, depth or microscopic characteristics suggest that further endoscopic resection would not be sufficient, other advanced techniques or surgical intervention may be considered.

The aim is to complete the treatment using a strategy proportionate to the actual characteristics of the lesion.

What happens if the test detects cancer

Finding a cancerous focus within a polyp does not automatically mean that surgery is required, nor does it in itself confirm that the polypectomy was sufficient.

The team analyses the depth to which the tumour cells have penetrated the wall, the resection margins and other microscopic features associated with the risk of residual disease or lymph node involvement.

Where the risk is considered sufficiently low and the lesion has been removed in accordance with appropriate criteria, endoscopic resection may constitute the definitive treatment, accompanied by the relevant follow-up.

If there are features indicating a higher risk, further tests and a surgical assessment may be necessary. Complex cases are reviewed by a multidisciplinary team.

Situations requiring specific assessment

Anticoagulant or antiplatelet treatment

These medicines may alter the risk of bleeding during and after polypectomy. Their management is planned taking into account both the haemorrhagic risk of the procedure and the risk of thrombosis associated with discontinuing treatment.

Heart, respiratory, kidney or liver diseases

Certain conditions may influence sedation, preparation for the procedure and subsequent follow-up. Planning is adapted to the patient’s clinical condition and the anticipated complexity of the resection.

Multiple polyps or family history

The presence of numerous polyps, lesions at an unusual age or a relevant family history may make it necessary to investigate the possibility of a hereditary predisposition and to adapt the follow-up.

Symptoms requiring medical assessment

Following a polypectomy, medical assessment should be sought in the event of heavy or recurrent bleeding, particularly if accompanied by dizziness, weakness or loss of consciousness.

Severe or progressive abdominal pain, significant abdominal distension, fever, chills, persistent vomiting or difficulty tolerating fluids also require attention.

The onset of shortness of breath, chest pain, loss of consciousness or a rapid deterioration in general health requires urgent medical attention.

The healthcare team can explain what minor changes might be expected following a specific resection and in which situations it is necessary to seek medical advice.

Specialists involved

Gastrointestinal polypectomy forms part of a process that begins with the detection and characterisation of the polyp, continues with the selection of the resection technique, and concludes with tissue analysis and the planning of follow-up care.

At the Publio Cordón Memorial Hospital, the Gastrointestinal Endoscopy Unit is the unit most directly involved in this treatment. It forms part of the Gastroenterology Department and carries out diagnostic and therapeutic endoscopy, polyp resection and advanced techniques for complex gastrointestinal lesions. The head of the unit has specific expertise in the prevention and early detection of gastrointestinal cancer, the resection of early-stage tumours and advanced therapeutic endoscopy.

The unit forms part of the Gastroenterology Department, which integrates clinical assessment with the various specialist units and enables decisions to be made as to when a lesion requires endoscopic treatment, surveillance or another approach.

Pathology plays a key role following resection, as microscopic analysis determines the nature of the polyp and provides the information needed to decide on follow-up or the need for further treatment.

When a lesion is identified with characteristics that may require surgery, the General and Gastrointestinal Surgery Department may be involved in the process to assess other treatment options. The hospital offers this speciality within the Metabolic Centre.

In the case of lengthy procedures or complex resections, Anaesthetology and Resuscitation may be involved in sedation and monitoring. The Memorial Publio Cordón Hospital offers this speciality as part of its range of healthcare services.

Not everyone requires the involvement of all these departments. The care pathway is tailored to the type of polyp, the technique required, the pathological findings and any potential need for endoscopic follow-up, advanced treatment or surgical assessment.

Preguntas frecuentes

Are polypectomy and biopsy the same thing?

Answer: No. A biopsy involves taking a small tissue sample for analysis, whilst a polypectomy aims to remove a lesion using endoscopy. The approach depends on the characteristics of the polyp: for some lesions, it may be useful to take samples beforehand, whilst for others, it is preferable to plan an appropriate endoscopic resection straight away.

Are all polyps found during a colonoscopy removed at the time?

Answer: Not necessarily. Many small colorectal polyps can be removed during the same examination, but large, flat lesions, those located in complex areas, or those with characteristics that require a more detailed assessment may need a specifically scheduled session or the involvement of an advanced endoscopy team.

What is the difference between a cool-touch handle and an electrically heated handle?

Answer: The cold snare allows the polyp to be cut without applying an electric current and is the preferred technique for many small colorectal polyps. For other lesions, a snare with controlled current may be used, which combines cutting and coagulation. The choice depends on the size, shape, location and other characteristics of the lesion.

What does it mean when a polyp has been removed in pieces?

Answer: It means that the lesion has been removed in several pieces rather than in a single piece. This approach may be suitable for certain large lesions, although it limits the ability to carry out a full assessment of the margins under the microscope and makes it particularly important to review the treated area subsequently.

When is a resection performed on fragments reviewed?

Answer: The timing depends on the size, location and technique used. In the colon and rectum, following a segmental resection of a lesion measuring 20 millimetres or more, European guidelines generally recommend an early follow-up colonoscopy at 3–6 months. The specific interval should be determined based on the endoscopic report, the histopathological result and the characteristics of the resection.

Does dysplasia mean there is cancer?

Answer: No. Dysplasia describes cellular changes that may be associated with an increased likelihood of progression, but it does not in itself equate to invasive cancer. Its significance depends on the grade of dysplasia and the other characteristics of the lesion.

Can bleeding occur after a polypectomy?

Answer: Yes. There may be some minor bleeding following certain resections, and there is also a possibility of delayed bleeding, which may begin hours or days later. Heavy or repeated bleeding, particularly if accompanied by dizziness, weakness or loss of consciousness, requires urgent medical attention.

When will the results of the polyp test be available?

Answer: The time required depends on the laboratory, the type of lesion and whether additional techniques or a specialist review are required. The team will inform you of how and when the pathological results will be communicated and of the next steps once they are available.

Will it be necessary to have another colonoscopy after a polypectomy?

Answer: It depends on the number, size and type of polyps, the quality of the examination, and whether the resection is considered complete. Some people need a follow-up examination of the treated area in the near future, whilst others may return to their usual screening programme or require check-ups at longer intervals.

What happens if the test finds cancer within the polyp?

Answer: The next step depends on the depth of invasion, the resection margins and other microscopic features relating to the risk of residual disease or lymph node involvement. In some very superficial cancers, endoscopic resection may be sufficient; in other cases, further tests or surgery may be necessary. The decision is based on the full report and, where appropriate, a multidisciplinary assessment.

Can I take my anticoagulants or antiplatelet medication before a polypectomy?

Answer: The treatment plan should be determined by the team in charge. These medicines must not be discontinued or altered on one’s own initiative, as the decision must balance the risk of bleeding associated with the resection against the risk of thrombosis that could result from discontinuing them.

Does polypectomy completely prevent colorectal cancer?

Answer: No. The removal of adenomas and certain serrated lesions reduces the risk associated with those lesions, but it does not prevent new polyps or cancer from developing in other parts of the colon in the future. For this reason, the recommended follow-up after polypectomy remains important.

Medical information for general guidance

This factsheet aims to help you understand what a gastrointestinal polypectomy is, when it may be necessary, how the resection technique is chosen, what information is provided by the analysis of the polyp, and how the subsequent follow-up is decided. It also explains why some lesions can be removed during the first endoscopy whilst others require specific planning.

At the Publio Cordón Memorial Hospital, we believe it is important for medical information to be accurate, understandable and useful in guiding each individual through their care journey. Our specialists devote part of their work to explaining conditions, tests and treatment options in an accessible way, helping patients and their families to better understand each stage and participate with greater confidence in decisions about their health. This commitment to knowledge and public outreach is also part of our dedication to research and the advancement of medicine.

The information contained in this factsheet outlines the general principles of gastrointestinal polypectomy. The need to remove a lesion, the technique chosen and the follow-up care must be tailored to each individual based on the lesion’s size, shape, location, endoscopic appearance, histopathological findings and clinical circumstances.