Polypectomy

Polypectomy is a medical procedure aimed at the removal of polyps that can form in any part of the digestive system, including the colon, the most frequent site on which we will focus in the course of the article. Today, in most cases, polypectomy takes place. endoscopically, often already during an exploratory colonoscopy. The alternative to this technique is open abdomen surgery.

Why Undergo Polypectomy?

Intestinal polyps are soft bumps that form on the mucous membrane of the intestine, especially in the colon and rectum. Particularly frequent after age 50, some of these polyps, called adenomas, can go against a slow one (usually 5- 10 years) but inexorable malignant evolution, or in any case causing various problems such as bleeding or intestinal obstruction.

It is now recognized that most of the malignant tumors of the intestine derive from polyps. The chances of a polyp turning into a malignant tumor can be quantified based on the characteristics of the polyp itself, observed during colonoscopy; require removal, the doctor may decide to do it immediately, without the need to repeat the endoscopic investigation again.

The choice to carry out the polypectomy operations immediately or not is influenced by the characteristics of the polyp and by those of the patient, which together make it possible to quantify the bleeding risk. If this appears concrete, the patient will be invited to undergo a polypectomy in one session next one.

Examination execution

The polypectomy procedure usually takes place in the Day Hospital regime, after carrying out a limited number of laboratory tests and the implementation of a series of rules that we will analyze in detail in the next chapter.

During the examination, the patient is normally lying on his left side, more or less deeply sedated by oral or intravenous administration of drugs which contribute to making the examination less painful and more bearable. Based on the evaluation of the individual clinical case, the medical staff can decide the degree of sedation required or even propose the execution of the procedure under general anesthesia.

Just like during a normal exploratory colonoscopy, the instrument (the colonoscope) is introduced through the anus and traced back, if possible, to the ileocecal valve and / or to the last ileal loops.

In order to stretch the intestinal walls and facilitate visual examination, air is introduced into the colon through the colonoscope, air which may cause some discomfort even at the end of the examination. The insufflation of air, in particular, can cause causing swelling and painful tension of the abdomen, as well as producing a feeling of need to evacuate.

Once the polyp to be removed has been identified, the technique generally involves the recession at the base of the peduncle, thanks to the aid of a particular loop-shaped electrosurgical unit. Through this instrument, capable of throttling the polyp at the base, electrical impulses are transmitted which at the same time they cut and coagulate the tissue, thus helping to stop the bleeding. Once cut, if possible, the polyp is recovered for histological examination.

Not all polyps are pedunculated; the sessile ones, for example, are completely adhered to the bowel wall and in this case it may be necessary to detach them piece by piece, thus repeating the colonoscopy on several occasions. When the polyp is very large or does not have a stalk, the doctor may decide to inject a vasoconstrictor drug, such as adrenaline, at the base of the polyp, which reduces the risk of bleeding. An injection can also be given at the site of the removal. of India ink diluted with physiological solution (tattoo), to facilitate subsequent endoscopic checks and / or surgical interventions.

Regardless of the polypectomy technique adopted, after the removal the entire polyp or its fragments are - if possible - recovered and sent to the laboratory for histological analysis; by examining the characteristics of the polyp, the anatomist-pathologist can thus establish whether they will be whether or not further checks and / or interventions are necessary In a fortunately limited number of cases, for example, it may happen that the examination reveals the presence of tumor cells at the base of the polyp or of the peduncle; in this case the polypectomy cannot be considered decisive and surgery may be necessary to remove the part of the colon where the polyp was located. Alternatively, the so-called mucosectomy - submucosal dissection, a technique that together with the polyps allows to remove the inner mucous layer of the intestinal wall can be performed already during the first poipectomy surgery. In this case, if the malignant lesions are confined within the mucous layer of the bowel wall, mucosectomy can be considered as a solution.

Is polypectomy safe? Are there any risks and complications?

Like all invasive procedures, polypectomy is also fraught with risks and complications. The most important ones, as anticipated, concern possible haemorrhagic outcomes, which occur in up to three cases out of 100 and which fortunately in most cases are self-limited or are stopped endoscopically. Only in rare circumstances can blood loss take on such a magnitude as to require a blood transfusion or surgery. This is more likely in the case of sessile (peduncleless) or large (> 2 cm) polyps.

Another relatively frequent complication of polypectomy is the perforation of the intestinal wall, which occurs in 0.3-0.4% of cases; this complication can be controlled by interrupting the diet associated with antibiotics, while in cases more serious ones may require immediate surgical intervention. The risk of peritonitis, significantly limited by antibiotic prophylaxis, is also fearful.

Sedation can lead to dizziness, nausea, and fatigue, which usually subside spontaneously within hours.

After the treatment, which lasts from 15 to 90 minutes, many patients complain of abdominal swelling problems, which can persist for a few hours during which they tend to reduce spontaneously; if this does not happen the evacuation of the gases can be favored by the insertion of a rectal probe (a small tube in the anus).

Mucosectomy is burdened with the same possible complications as polypectomy, but with a higher incidence.

Preparation for polypectomy surgery

The preparation for polypectomy is similar to that already seen for colonoscopy, to which we refer for more information. Briefly, starting from the 3/4 days preceding the examination, the person is invited to follow a diet free of dairy products and waste (no vegetables and fruit of any kind should be consumed).

Before the exam it is necessary to fast for a minimum of 6 hours, to avoid nausea and vomiting problems; if the exam takes place in the afternoon, a light breakfast is allowed early in the morning.

Starting from the morning of the day before the examination, as prescribed by the doctor, it is necessary to undertake a colon cleansing by using laxatives combined with large quantities of water (ISOCOLAN and PURSENNID).

Before the examination it is advisable to inform the doctor of any allergy to certain drugs or to latex.

According to medical indications, in the seven days preceding the polypectomy, treatment with oral anticoagulants, such as warfarin, must be suspended or in any case re-adapted to avoid bleeding complications.

What to do after polypectomy

At the end of the polypectomy, the patient is observed for a variable time according to the degree of sedation, the clinical conditions, the size and characteristics of the removed polyp, as well as in relation to the procedure undertaken. For example, polypectomy and endoscopic mucosectomy of polyps larger than one centimeter typically involve 24-48 hours of hospital observation.

The patient will then be discharged as soon as the doctors deem it more appropriate. After discharge, the patient is asked to take absolute rest at home for at least 24 hours, avoiding excessive exercise for four days.

In the 24 hours following the polypectomy, the patient is given a liquid diet, therefore devoid of solid food. Even after discharge, a light diet, low in waste and solid or spicy foods is recommended for at least 48 hours, while alcohol should be avoided for at least three days.

Antibiotic prophylaxis can also continue at home, according to medical indications.

After the polypectomy, a period of false constipation is normal, as the operation is performed on a bowel emptied of stool, which will require a few days to return to a normal diet to refill. After the polypectomy, the immediate use of laxatives and enemas is therefore absolutely useless and dangerous.

If symptoms of vomiting, fever, difficulty in expelling air or bleeding arise, it is important to prolong the fast and promptly contact the emergency room or the medical facility that performed the polypectomy.