How are colon polyps removed?

Colon polyps can often be removed during the time of colonoscopy, but some require surgery.

Doctors remove polyps when they're discovered in colonoscopy. Instruments can bite, snare, or burn them with electricity.

Your doctor may destroy tiny colon polyps by fulguration (burning) or by removing them with wire loops called snares or with biopsy instruments. Your doctor will use a technique called "snare polypectomy" to remove larger polyps. Your doctor will pass a wire loop through the colonoscope and remove the polyp from the intestinal wall using an electrical current. You should feel no pain during the polypectomy (polyp removal).

The tiniest colon polyps are removed by burning or cauterizing them; larger colon polyps can usually be removed using a specially designed snare which cuts the stalk of a polyp and cauterizes it at the same time, so that it does not bleed. The snare is passed through a channel in the colonoscope to accomplish this.

Occasionally, surgery may be necessary to remove the polyps, either because the stalk or neck of the polyp is too broad to permit safe snaring, or because the colon is positioned in such a way that the colonoscope will not reach the polyp area safely.

The great majority of polyps, however, can be removed without surgery.

The following are ways that colon polyps may be removed:

  • Very basic, tiny colon polyps can be removed by a standard polypectomy, which is when a wire loop snare is used to encircle the polyp and pull it off. Cautery may even be used in this. A biopsy forceps can be used to achieve the same goal.
  • Endoscopic mucosal resection is a specific technique that addresses larger, more challenging polyps. A fluid dyed with methylene blue is injected to create a cushion to help define the margins. Some cautery marks may also be done to help find the margin. Then a wire loop snare is used to capture as much of the tissue as possible, and often with cautery, the lesion is cut off.
  • Larger lesions are often done in pieces, as opposed to one large chunk, because it's often safer that way. Lesions less that 2 cm to 2.5 cm often can be taken out in one piece, which is preferable if it's feasible. Hemostatic forceps may be used to ablate some of the vessels, hopefully to decrease the risk of bleeding.
  • Endoscopic submucosal dissection or ESD is a technique used at specialized centers. It's a little more difficult, but it has the advantage of allowing more reliable of larger lesions in one piece and may be appropriate if early cancer is suspected.

Polyps are generally able to be removed while the doctor is performing a colonoscopy, in which a camera is used to see the inside of the rectum and colon. Several different techniques are used to remove polyps, and it generally depends on the size and type of polyp. Some of the techniques include the snare with electrocautery, which is like a small noose that gets hot so it can cut the base of the polyp. Some polyps are so large, they must be divided into many separate pieces and collected in a net.

Removal of colon polyps is an important means of preventing colon cancer, as the majority of cancers develop from polyps.

Tiny polyps may be completely destroyed by biopsy. Larger polyps are removed by a technique called snare polypectomy, in which a wire loop is passed through the colonoscope and the polyps are cut from the intestinal wall by means of a small electrical current.

Colon polyps are removed in two ways, depending on the size of the polyp. Small ones can be removed with a grasper with small teeth, land arger ones can be snared on, like a lasso, with electrocurrent going through it to ensure that there's no bleeding.

There are a lot of good techniques for removing polyps from the colon including injecting saline just underneath the polyp to raise it up so surgeons can see it to remove it. However, there are some situations where polyps are either in a crevice and can’t be removed safely or surgeons have tried to remove a polyp several times and it continues to return. In those cases, sooner or later a person is going to come back with cancer there. Those are the people on whom we'll oftentimes perform a hemicolectomy to completely eradicate the area where the polyp is, or eradicate the polyp completely to prevent it from turning into cancer.

Some people have multiple polyps throughout their colon. They have 5 to 10 polyps in maybe a year or a year and half. In these people, doctors also use a more aggressive surgery to remove the area of the colon that is at risk.

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