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Endoscopic Polypectomy – Procedure and Cancer Prevention

Endoscopic polypectomy is a minimally invasive procedure to remove polyps from the gastrointestinal tract using an endoscope, without the need for open surgery.

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Things worth knowing about "Endoscopic Polypectomy"

Endoscopic polypectomy is a minimally invasive procedure to remove polyps from the gastrointestinal tract using an endoscope, without the need for open surgery.

What is Endoscopic Polypectomy?

Endoscopic polypectomy is a minimally invasive medical procedure used to remove polyps – benign or potentially malignant tissue growths – from the lining of the gastrointestinal (GI) tract. The procedure is performed using an endoscope, a flexible tube equipped with a camera and specialized instruments at its tip. No open surgery is required.

Polyps can develop anywhere along the digestive tract, but are most commonly found in the large intestine (colon) and rectum. Because certain types of polyps – especially adenomatous polyps – are associated with an increased risk of colorectal cancer, their early removal is a critical cancer prevention strategy.

When is Endoscopic Polypectomy Performed?

The procedure is recommended when polyps are detected during a colonoscopy, gastroscopy, or other endoscopic examination. Common indications include:

Detection of colorectal polyps during routine cancer screening
Investigation of gastrointestinal bleeding
Removal of polyps in the stomach or small intestine
Histological analysis (tissue examination) of a suspicious lesion

How is the Procedure Performed?

Endoscopic polypectomy is typically performed on an outpatient basis or with a short hospital stay. Depending on the size and location of the polyp, different techniques are used:

Biopsy Forceps (Cold-Biopsy Technique)

Small polyps (under 5 mm) can be removed directly using a specialized biopsy forceps. This method is quick and straightforward.

Snare Polypectomy

Larger polyps are encircled with a wire loop (snare) and removed using electrical current (high-frequency electrocautery). This technique, known as hot snare polypectomy, also allows simultaneous hemostasis (bleeding control).

Endoscopic Mucosal Resection (EMR)

For flat or broad-based polyps, a fluid is first injected beneath the mucosa to lift the polyp. It is then removed with a snare. This technique is called Endoscopic Mucosal Resection (EMR).

Endoscopic Submucosal Dissection (ESD)

For very large or difficult-to-reach polyps, Endoscopic Submucosal Dissection (ESD) is used, in which the polyp is precisely cut out in one piece using a specialized instrument. This technique is more technically demanding and is primarily performed in specialized centers.

Preparation for the Procedure

Before a colonoscopy with polypectomy, thorough bowel preparation is essential. This typically includes:

Taking a laxative the day before or the morning of the procedure
Following a low-fiber diet in the days prior to the procedure
Stopping or adjusting blood-thinning medications as directed by a physician

The procedure is usually performed under sedation or mild anesthesia, making it largely painless for the patient.

Risks and Complications

Endoscopic polypectomy is a safe procedure, but complications can occasionally occur:

Post-procedural bleeding: The most common complication, occurring in approximately 1–2% of cases, and usually manageable endoscopically.
Perforation (a hole in the bowel wall): Very rare; may require surgical treatment in severe cases.
Post-polypectomy syndrome: A localized inflammatory reaction of the bowel wall causing abdominal pain and fever after the procedure; usually self-limiting.

Follow-Up and Outcomes

After polypectomy, the removed tissue is examined histologically (under a microscope) to determine the type and nature of the polyp. Based on the results, further measures may be recommended:

For benign polyps without dysplasia: follow-up colonoscopy in 3–5 years
For adenomatous polyps with high-grade dysplasia or multiple polyps: closer surveillance colonoscopy in 1–3 years
If carcinoma cells are found: further oncological diagnostics and treatment are initiated

In the days following the procedure, patients should avoid physical exertion, alcohol, and blood-thinning medications, and should watch for warning signs such as severe abdominal pain or persistent bleeding.

Importance for Cancer Prevention

Endoscopic polypectomy is considered one of the most effective methods for preventing colorectal cancer. Studies show that the regular removal of adenomas significantly reduces the risk of developing colorectal carcinoma. Colonoscopy screening is recommended and often covered by health insurance for adults from age 45 to 50, depending on national guidelines.

References

Zauber A.G. et al. - Colonoscopic Polypectomy and Long-Term Prevention of Colorectal-Cancer Deaths. New England Journal of Medicine, 2012.
Hassan C. et al. - Endoscopic submucosal dissection versus endoscopic mucosal resection for large colorectal lesions. Gastrointestinal Endoscopy, 2016.
World Health Organization (WHO): Global Cancer Observatory – Colorectal Cancer Fact Sheet, 2022.

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