Gastroscopy
CLINICAL ASSOCIATE PROFESSOR, SYDNEY UNIVERSITY
GASTROENTEROLOGIST AND THERAPEUTIC ENDOSCOPIST
PAST CHAIRMAN OF ENDOSCOPY, GASTROENTEROLOGY
SOCIETY OF AUSTRALIA
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Large Polyps
Large Polyps
What is a Polyp?
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Polyps are growths that develop on the internal lining of the colon. They start very small but then grow into large sizes and most experts would call a polyp that is more than 2cm as a large polyp. Most Polyps will grow into cancers if enough time passes. Polyps can grow in 2 ways. Firstly thye can appear like a mushroom (pedunculated) or they can be flat (sessile) like a mole on the skin surface. These two main shapes require different techniques and accessories to remove. Both can be done safely in expert hands.
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How do we develop Large Polyps?
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It's really a matter of time. The longer a polyp has to grow the larger it will be. Larger polyps also have more time to develop samll areas of cancer and so the final pathology reports are very important. There is no clear reason why some people develop pedunculated and others develop sessile polyps. There is no real difference other than the way we remove them.
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How are they removed?
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Most doctors are experienced in removing polyps smaller than 2cm (20mm). However, few doctors have special training and interest in removing large polyps. The techniques and accessories are difficult to use and require expertise.
Pedunculated: even though these can be removed safely bleeding even after 1 week is the main problem. New accessory tools are used in this situation to prevent bleeding and have been shown to be very effective.
What happens after a colonoscopy?
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Your physician will explain the results of the examination to you, although you'll probably have to wait for the results of any biopsies performed.
If you have been given sedatives during the procedure, someone must drive you home and stay with you. Even if you feel alert after the procedure, your judgment and reflexes could be impaired for the rest of the day. You might have some cramping or bloating because of the air introduced into the colon during the examination. This should disappear quickly when you pass gas.
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You should be able to eat after the examination, but your doctor might restrict your diet and activities, especially after polypectomy.
What are the possible complications of polypectomy?
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Colonoscopy and polypectomy are generally safe when performed by doctors who have been specially trained and are experienced in these procedures.
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One possible complication is a perforation, or tear, through the bowel wall that could require surgery. Bleeding might occur at the site of biopsy or polypectomy, but it's usually minor. Bleeding can stop on its own or be controlled through the colonoscope; it rarely requires follow-up treatment. Some patients might have a reaction to the sedatives or complications from heart or lung disease.
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Although complications after colonoscopy are uncommon, it's important to recognize early signs of possible complications. Contact your doctor if you notice severe abdominal pain, fever and chills, or rectal bleeding of more than one-half cup. Note that bleeding can occur several days after the procedure.
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Large Polyp
Large polyp seen here outlined by the arrows. It is involving the colon circumferentially (all the way around)
The blue dye and injection helps resect the polyp piece by piece as seen here. There is still more polyp yet to be cleared in this picture.
The polyp has completely been resected.
