Gastric and Colonic Polyps — Diagnosis and Polypectomy

What Are Polyps?

Polyps are abnormal tissue growths that protrude from the inner lining (mucosa) of the digestive tract. They can occur anywhere in the gastrointestinal tract but are most commonly found in the colon (large intestine) and stomach. Polyps vary in size, shape, and type — and importantly, some types carry the potential to develop into cancer over time. Detecting and removing polyps is one of the most effective strategies for preventing colorectal cancer.

Types of Polyps

Colonic Polyps

• Adenomatous polyps (adenomas) — the most clinically significant type. These are precancerous growths that can progress through the adenoma-carcinoma sequence to become colorectal cancer over 10-15 years. Subtypes include tubular, villous, and tubulovillous adenomas. Villous adenomas carry the highest malignant potential.
• Sessile serrated polyps (SSP) — flat or slightly raised polyps, most common in the right colon. Previously under-recognized, these are now known to be precursors to approximately 20-30% of colorectal cancers via the serrated neoplasia pathway. They require careful detection and complete removal.
• Hyperplastic polyps — the most common type, typically small and found in the rectum and sigmoid colon. Generally considered to have minimal or no malignant potential.
• Traditional serrated adenomas — uncommon, but considered precancerous
• Hamartomatous polyps — occur in polyposis syndromes (Peutz-Jeghers, juvenile polyposis)

Gastric Polyps

• Fundic gland polyps — the most common type of gastric polyp, often associated with proton pump inhibitor use. Generally benign with very low malignant potential.
• Hyperplastic polyps — associated with H. pylori infection and chronic gastritis. Small risk of dysplasia in larger polyps.
• Gastric adenomas — true precancerous lesions that require removal and surveillance

Symptoms

The vast majority of polyps are completely asymptomatic, which is why screening is so important. When symptoms do occur, they may include:

• Rectal bleeding — blood in or on the stool, though most rectal bleeding has other causes (hemorrhoids)
• Iron deficiency anemia — from chronic, occult bleeding (particularly with larger polyps)
• Change in bowel habits — rare, typically only with very large polyps
• Abdominal pain — uncommon, may occur with large polyps causing partial obstruction
• Mucus in the stool — occasionally seen with large villous adenomas

Diagnosis

• Colonoscopy — the gold standard for detecting and removing colonic polyps. Allows direct visualization, characterization, and removal in a single procedure.
• Upper endoscopy (EGD) — for detecting and evaluating gastric polyps
• Fecal occult blood testing (FOBT) and fecal immunochemical testing (FIT) — screening tests that detect microscopic blood in the stool, prompting colonoscopy when positive
• CT colonography (virtual colonoscopy) — a non-invasive alternative for polyp detection, though any found polyps still require colonoscopy for removal

Polypectomy Techniques

Polyp removal (polypectomy) is performed during diagnostic and therapeutic endoscopy using techniques tailored to the polyp size, shape, and location:

• Cold forceps polypectomy — for diminutive polyps (under 3 mm), using biopsy forceps to grasp and remove the polyp
• Cold snare polypectomy — the preferred technique for polyps up to 10 mm. A thin wire snare is placed around the polyp base and closed to cut the polyp without electrocautery, minimizing the risk of perforation and delayed bleeding.
• Hot snare polypectomy — for larger pedunculated (stalked) polyps, using a snare with electrocautery. The stalk may be injected with diluted epinephrine or clipped before cutting to reduce bleeding risk.
• Endoscopic mucosal resection (EMR) — for larger flat or sessile polyps (10-20 mm or larger). Saline or other solution is injected beneath the polyp to lift it from the muscle layer, then a snare is used for removal, often in a piecemeal fashion for very large lesions.
• Endoscopic submucosal dissection (ESD) — for very large polyps or early cancers where en-bloc (single-piece) removal is needed. A highly specialized technique.

Colonoscopy Preparation for Polypectomy

• Follow the prescribed bowel preparation regimen carefully — a clean colon is essential for safe and complete polyp removal
• Inform your doctor about all medications, especially blood thinners (aspirin, clopidogrel, warfarin, DOACs) which may need to be adjusted or stopped before the procedure
• Follow dietary restrictions as instructed (typically clear liquids the day before)
• Arrange transportation home, as sedation is used during the procedure

Recovery After Polypectomy

• Diet — light, easily digestible foods for 24-48 hours. Avoid spicy foods, alcohol, and high-fiber foods initially. Resume normal diet gradually.
• Activities — avoid strenuous exercise and heavy lifting for 3-5 days after removal of larger polyps. Walking is encouraged.
• Medications to avoid — NSAIDs (ibuprofen, aspirin) and blood thinners should be avoided as directed by your doctor, typically for 5-7 days after polypectomy, to reduce bleeding risk.
• Watch for complications — contact your doctor if you experience significant rectal bleeding, severe abdominal pain, fever, or dizziness.
• Delayed bleeding — can occur up to 2 weeks after polypectomy. Minor spotting is common; significant bleeding requires medical attention.

Surveillance Colonoscopy Schedule

After polyp removal, the timing of your next colonoscopy depends on the findings:

• Low-risk findings (1-2 small tubular adenomas under 10 mm) — repeat colonoscopy in 5-7 years
• High-risk findings (3 or more adenomas, any adenoma 10 mm or larger, villous histology, high-grade dysplasia) — repeat colonoscopy in 3 years
• Sessile serrated polyps (10 mm or larger, or with dysplasia) — repeat colonoscopy in 3 years
• Piecemeal EMR of large polyps — follow-up colonoscopy in 6 months to check for residual tissue, then at the interval determined by overall findings
• Normal colonoscopy (no polyps) — repeat in 10 years
• These intervals are based on current guidelines and may be adjusted by your gastroenterologist based on individual risk factors.

Cancer Prevention

Colorectal cancer is one of the most preventable cancers. Screening colonoscopy with polypectomy reduces colorectal cancer incidence by approximately 40-60% and colorectal cancer mortality by a similar magnitude. The key is to detect and remove precancerous polyps before they have the opportunity to transform into cancer — a process that typically takes 10-15 years, providing a wide window for intervention.

Current guidelines recommend screening colonoscopy beginning at age 45 for average-risk individuals. Earlier and more frequent screening is recommended for those with a family history of colorectal cancer or polyps, personal history of inflammatory bowel disease, or known hereditary syndromes.

Practical Tips

• Do not postpone your screening colonoscopy — it is one of the most impactful preventive health measures available
• If polyps are found, adhere strictly to your recommended surveillance schedule
• Maintain a healthy lifestyle: regular physical activity, a diet rich in fruits, vegetables, and whole grains, limited red and processed meat, moderate alcohol consumption, and no smoking
• Report any persistent changes in bowel habits or rectal bleeding to your doctor promptly
• Share your colonoscopy findings with first-degree relatives, as their screening recommendations may be affected