What are polyps?

Polyps, growths on the intestinal and gastric mucosa, are generally harmless. However, certain types of polyps (called adenomas) can become cancerous if left untreated and reach a significant size. Research has shown that the majority of malignant intestinal tumors initially developed from benign polyps. Therefore, it's imperative to remove polyps from the stomach and intestines. Fortunately, thanks to endoscopy, this procedure can now be performed without surgery, unlike in the past. This eliminates the risks and inconveniences associated with surgical intervention.

 

What are the symptoms and signs associated with intestinal polyps?

Intestinal polyps, especially when single, small, flat, and only a few millimeters in size, are usually asymptomatic, meaning they cause no symptoms. This characteristic adds to their dangerousness, as the polyp has sufficient time to develop into a malignant tumor (this process generally takes about ten years). Often discovered incidentally during an endoscopic or radiological examination performed for other reasons, or during an autopsy, these asymptomatic polyps may go unnoticed until it's too late.

 

Intestinal polyps can cause several symptoms and signs when numerous, pedunculated, and large. These manifestations may include:

• Abdominal cramps
• Watery diarrhea with possible consequent hypokalemia;
• Constipation;
• Flatulence;
• Abdominal pain;
• Abdominal bloating;
• Dyspepsia (digestive difficulties);
• Difficulty defecating;
• Symptoms and signs of anemia;
• Abdominal cramps;
• Pallor;
• Rectal bleeding (bleeding from the anus);
• Presence of bright red blood in the stool (in case of hemorrhagic lesion in the terminal part of the colon);
• Dark red blood in the stool or melena (black stools) in case of hemorrhagic lesion in the first part of the colon);
• Presence of occult blood in the stool (not macroscopically visible);
• Rectal tenesmus (sensation of urgent need to defecate), especially if the polyps are located in the rectum;
• Sensation of a foreign body near the anus (especially if the polyps are located in the rectum);
• Severe abdominal colic and other manifestations of intestinal obstruction may occur in the presence of numerous intestinal polyps or large polyps;

In general, symptoms and signs are more frequent and intense when the polyp is large. In case of severe intestinal obstruction, it is possible to suffer from fecal vomiting, that is to say, to expel stool through the mouth.

 

How to remove intestinal polyps?

Preparing for polypectomy

Before polypectomy, it is essential that the patient fast for at least 4 hours to avoid the risk of nausea and vomiting. If the examination is scheduled for the afternoon, a light breakfast is allowed in the early morning. The day before the procedure, according to the doctor's recommendations, it is imperative to clean the intestines by taking laxatives with water or uncolored drinks. Nowadays, the latest protocols allow to minimize the doses of laxatives, with only one liter of preparation and one liter of uncolored liquid. To ensure a safe operation without bleeding, it is important to mention to the doctor any potential use of medications (anticoagulants, antiplatelet agents such as aspirin or anti-inflammatories) that may affect blood clotting. It is recommended to suspend or adjust these medications in the five days preceding the polypectomy to prevent any complications.

 

Polypectomy procedure

A doctor can use a delicate and flexible instrument with a camera at its end or lenses (through fiber optics) and equipped with integrated lighting. By inserting it through the mouth (gastroscopy) or rectum (colonoscopy), they can identify the polyps. These can be either pedunculated or sessile. Pedunculated polyps are easily removed in one piece by sectioning them at the base. In some situations, lasers are also used to burn the base of large polyps. It is crucial to remove the polyp entirely to avoid any future recurrence.

 

Histological examination

Before performing the polypectomy, the doctor has the possibility of taking tiny tissue samples (biopsies) which will then be subjected to microscopic or histological analysis. This histological examination is essential because it allows to diagnose the exact nature of the polyp and to determine whether further checks are necessary. When dealing with large polyps, it is generally essential to perform additional examinations to rule out the presence of dysplastic cells (transforming cells) and, if applicable, determine their exact location. Although endoscopic polypectomy is a definitive measure in most cases, surgery is necessary when the cells show a high degree of transformation (severe dysplasia) at the base of the polyp or in its peduncle. The aim is then to remove the affected section of the intestine or stomach.

 

What are the complications related to polypectomy?

Polypectomy is a safe procedure. However, it is crucial that the patient's blood coagulation is normal in order to safely perform the polypectomy. Therefore, the patient will undergo blood tests to check their coagulation ability. It is also essential to inform the doctor of any medication taken by the patient, such as anticoagulants, antiplatelet agents (such as aspirin) or anti-inflammatories, which may alter blood coagulation. Fortunately, complications related to polypectomy are rare. The major complications to watch out for after polyp removal are bleeding and perforations at the surgical site, especially when it comes to large polyps. Fortunately, these two problems can be effectively treated by medical or endoscopic methods, thus eliminating the need for surgery in most cases.

 

Why and how to screen for intestinal polyps?

As stated earlier, although polyps are benign growths, they can evolve into carcinomas over time (approximately 10 years). This is why it is crucial to identify and remove intestinal polyps in order to effectively prevent colorectal cancer. To optimize health, it is recommended to have a colonoscopy after the age of 50, particularly for individuals with several risk factors, such as a family history of colon cancer, obesity, smoking and alcoholism, as more than 40% of people over 60 have adenomatous polyps. In addition to endoscopy, a complementary diagnostic examination can be performed: colon X-ray. In combination, a search for occult blood in the stool can be performed. A virtual colonoscopy can also be used.

 

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