Colonic polypectomy

The method used to perform colonic polypectomies during colonoscopy depends on the size, shape and histological type of the polyp to be removed. Prior to performing polypectomy, polyps can be biopsied and examined histologically to determine the need to perform polypectomy.

Gastrointestinal polyps can be removed endoscopically through colonoscopy or esophagogastroduodenoscopy, or surgically if the polyp is too large to be removed endoscopically.

Small polyps (less than 5mm)

Small polyps can removed by hot biopsy: biopsy forceps are closed over the polyp, and electric current is passed through the forceps to provide electrocautery. This reduces the chances of bleeding from the polyp base, and improves the chance of complete removal of the polyp by destroying the tissue at the base of the polyp.

Very small polyps (up to 3mm) can be removed by cold biopsy, where biopsy forceps alone are used to remove the polyp, without electrocautery; but risks incomplete removal of the polyp, but reduces the risk of colonic perforation. These polyps may also be removed by fulguration using Argon plasma coagulation to destroy the polyp; the disadvantage of this technique is that no tissue is obtained for histological analysis.

Slightly larger polyps (4-8mm) may be removed by snare cautery (see below).

Polyp is identified, snare is passed over stalk and polyp is then removed

Polypectomy snare

Larger, sessile polyps

These polyps are more difficult to remove endoscopically, and polypectomy in these cases has a higher risk of complication. Sessile polyps up to 10mm can often be removed by snare polypectomy. Polyps over 10mm may have to be removed piecemeal by snare polypectomy. The use of electrocautery over a large area has a significant risk of causing colonic perforation; to reduce this chance, and to facilitate the polypectomy, sterile fluid (saline or colloid, with methylene blue dye added) can be injected under the base of the polyp to raise it away from the muscular layers of the colon.

Larger, pedunculated polyps

Pedunculated polyps can be removed by snare polypectomy. When the polyp is identified, a polypectomy snare is passed over the polyp and around the stalk of the polyp. The loop of the snare is then tightened to grip the polyp stalk, and the polyp is pulled away from the wall of the colon. An electric current is then passed through the snare loop to cut through the polyp stalk, while providing electrocautery at the same time. The polyp can then be retrieved using the snare, or an endoscopy basket, and removed by withdrawing the colonoscope.

Complications

The commonest complications of colonic polypectomy are bleeding and colonic perforation.

External links

• DAVE Project videos of polypectomy. Retrieved March 26, 2010.
• "How I Do It" — Removing large or sessile colonic polyps.

This medical treatment-related article is a stub. You can help Wikipedia by expanding it.v · Categories: Medical tests Endoscopy Digestive system surgery Medical treatment stubs Wikimedia Foundation. 2010. Игры ⚽ Поможем решить контрольную работу Coloniatherium Intestinal spirochetosis Look at other dictionaries: Polypectomy — is the removal of a polyp through colonoscopy, a type of endoscopy.External links* [http://www.omed.org/downloads/pdf/publications/how i doit/2007/omed hid removing large or sessile colonic polyps.pdf How I Do It Removing large or sessile colonic …   Wikipedia Colonoscopy — Intervention ICD 9 CM 45.23 MeSH …   Wikipedia Colectomy — Intervention Micrograph of pseudomembranous colitis, an indication for colectomy. H E stain. ICD 9 CM …   Wikipedia Surgery — This article is about the medical specialty. For other uses, see Surgery (disambiguation). A cardiothoracic surgeon performs a mitral valve replacement at the Fitzsimons Army Medical Center. Surgery (from the Greek …   Wikipedia Esophageal motility study — Intervention Diagram of esophageal motility study in nutcracker esophagus. The disorder shows peristalsis with high pressure esophageal contractions exceeding 180 mmHg and contractile waves with a long duration exceeding 6 seconds …   Wikipedia Laparotomy — Intervention Abdominal cavity ICD 9 CM …   Wikipedia Nasogastric intubation — Intervention Stomach tube (Levin type), 18 Fr × 48 in (121 cm) ICD 9 CM …   Wikipedia Liver transplantation — Intervention Human liver ICD 9 CM 50.5 …   Wikipedia Rectal examination — Intervention Digital rectal exam: side view of the male reproductive and urinary anatomy, including the prostate, rectum, and bladder. ICD 9 CM 89.34 …   Wikipedia Cholecystectomy — Intervention ICD 9 CM 51.2 MeSH …   Wikipedia 18+ © Academic, 2000-2024 Contact us: Technical Support, Advertising Dictionaries export, created on PHP, Joomla, Drupal, WordPress, MODx. Mark and share Search through all dictionaries Translate… Search Internet Share the article and excerpts Direct link … Do a right-click on the link above and select “Copy Link”