A polypectomy is a procedure to remove a polyp, which is an abnormal growth on the inner lining of an organ. Most polypectomies involve the colon and are performed during a routine colonoscopy, but polyps can also be removed from the uterus, stomach, gallbladder, and vocal cords. The procedure is one of the most effective ways to prevent colorectal cancer, since many colon polyps are precancerous growths that can become malignant over time if left in place.
Where Polyps Form and Why They’re Removed
Polyps are small clumps of tissue that project from the moist lining of hollow organs. In the colon, they’re extremely common, especially after age 50. Most are harmless, but certain types slowly accumulate genetic changes that can lead to cancer over years or decades. Removing them during a colonoscopy eliminates that risk before it develops.
Uterine polyps grow from the lining of the uterus and can cause irregular bleeding, heavy periods, or fertility problems. Stomach polyps are usually found incidentally during an upper endoscopy. In each case, the reasoning is similar: remove the growth, send it to a lab, and find out whether it’s benign or needs further attention.
How Colon Polyps Are Removed
During a colonoscopy, your doctor can remove most polyps on the spot using instruments passed through the scope. The specific technique depends on the polyp’s size and shape.
For small polyps under about 10 mm, the most common approach is cold snare polypectomy. A thin wire loop is placed around the base of the polyp, tightened, and used to slice through the tissue without any electrical current. Because there’s no heat involved, the risk of burning deeper tissue or causing a delayed bleed is very low. You may have brief oozing at the removal site, but this typically stops on its own. Cold snare has become the preferred technique for most small polyps because it’s fast, safe, and removes the polyp completely.
Hot snare polypectomy uses the same wire loop but adds an electrical current that cuts and cauterizes at the same time. The advantage is less immediate bleeding, since the heat seals blood vessels as it cuts. The tradeoff is a small additional risk of damaging deeper layers of the colon wall, which can lead to delayed bleeding or, rarely, perforation. Hot snare is generally reserved for larger polyps or situations where the extra cauterization is helpful.
For polyps larger than about 10 mm, doctors often use a technique called endoscopic mucosal resection, which involves injecting fluid beneath the polyp to lift it away from the deeper tissue before snaring it off. Polyps bigger than 15 to 20 mm usually need to be removed in pieces. For very large or complex growths, particularly those with a higher likelihood of containing early cancer, endoscopic submucosal dissection allows the entire lesion to be removed in one piece regardless of size. This is a more specialized procedure typically performed at referral centers.
How Uterine Polyps Are Removed
Uterine polyps are removed through a procedure called hysteroscopy. A thin, lighted scope is inserted through the vagina and cervix into the uterus. A liquid solution gently expands the uterine cavity so the doctor can see clearly, and small surgical instruments passed through the scope are used to cut away the polyp.
The procedure is usually done under sedation or general anesthesia. Recovery is relatively quick: you can expect mild cramping and light bleeding for a few days afterward. Most people are advised to avoid using tampons, having intercourse, douching, swimming, and taking baths for about two weeks to let the area heal.
Preparation for a Colonoscopic Polypectomy
Since most polypectomies happen during a colonoscopy, the preparation is the same: you need to completely empty your colon so the lining can be clearly seen. This typically starts one to two days before the procedure. You’ll switch to a low-fiber diet, cutting out whole grains, nuts, seeds, and raw fruits and vegetables. The day before, you’ll stop eating solid food entirely and stick to clear liquids like water, tea, and coffee without milk. You’ll also drink a bowel-cleansing solution that flushes everything out.
You’ll receive sedation for the colonoscopy, so you’ll need someone to drive you home. The colonoscopy itself usually takes 30 to 60 minutes, and removing polyps adds only a small amount of time to the procedure.
Risks and Complications
Polypectomy during colonoscopy is considered very safe. In a large population-based screening study of over 121,000 patients, the rate of hospitalization for post-polypectomy bleeding was 4.3 per 1,000 procedures. For complex polypectomies involving larger or more difficult polyps, that rate was higher at about 14 per 1,000. Perforation, a small tear in the colon wall, was even rarer at roughly 0.5 per 1,000, and that rate has declined over time as techniques have improved.
Bleeding can happen immediately or show up days later. If you notice significant rectal bleeding, persistent abdominal pain, fever, or dizziness in the two weeks after your procedure, those warrant prompt medical attention.
Recovery and Diet After the Procedure
After a straightforward colonoscopic polypectomy, most people go home the same day and feel normal within 24 hours. You may have mild bloating or cramping as the air introduced during the scope works its way out. Light activity is fine, though you’ll generally want to take it easy for the rest of the day.
Dietary advice varies. After cold snare removal of small polyps, some doctors recommend a low-residue diet for about three days, avoiding high-fiber foods like leafy greens, mushrooms, root vegetables, and legumes while sticking to easily digested options like rice, noodles, eggs, and yogurt. Alcohol is typically off-limits for about a week. If you’re on blood thinners, your doctor will give you specific instructions about when to restart them, since these medications increase bleeding risk at the removal site.
What the Pathology Report Tells You
Every removed polyp is sent to a lab for examination under a microscope. Results typically come back in one to two weeks. The pathology report will classify the polyp into one of several categories, and this classification determines both how concerned you need to be and when you’ll need your next colonoscopy.
Hyperplastic polyps are small, noncancerous growths most often found in the lower colon or rectum. They carry very little risk, and finding them doesn’t change your screening timeline.
Tubular adenomas are the most common precancerous polyp type. They grow slowly and have a low but real chance of becoming cancerous if left alone for years. Most polyps removed during screening fall into this category.
Villous or tubulovillous adenomas are a step up in risk. These polyps have a higher chance of harboring or developing into cancer, so follow-up is scheduled sooner.
Sessile serrated lesions are flat or slightly raised growths that tend to appear in the upper colon. They can be hard to spot during colonoscopy because of their flat shape, and they follow a different pathway to cancer than traditional adenomas.
Inflammatory polyps are linked to chronic inflammation in the colon and are not cancerous. Hamartomatous polyps are rare and sometimes associated with inherited genetic syndromes.
Follow-Up Screening Schedules
Your pathology results directly determine when you’ll need your next colonoscopy. The guidelines are specific and based on the number, size, and type of polyps found.
- No polyps or only small hyperplastic polyps: You won’t need another colonoscopy for 10 years.
- 1 or 2 small tubular adenomas (under 10 mm): Follow-up screening in 5 years.
- 3 or 4 small tubular adenomas: Colonoscopy in 5 years.
- 5 to 10 adenomas, any adenoma 10 mm or larger, or any with villous features or high-grade abnormality: Colonoscopy in 3 years.
- More than 10 adenomas: Colonoscopy in 1 year, with consideration for genetic counseling.
- 1 or 2 small sessile serrated lesions: Colonoscopy in 5 years.
- 3 or more sessile serrated lesions, any large serrated lesion, or serrated lesions with abnormal cells: Colonoscopy in 3 years.
These intervals are designed to catch any new growths early without subjecting you to more procedures than necessary. If your follow-up colonoscopy comes back clean or shows only one or two small, low-risk polyps, the interval between future exams can be stretched out even further.