What Is Complex Polypectomy?

Colonoscopy is the gold standard for colorectal cancer detection. One of the amazing things about a colonoscopy is that it is one of the few diagnostic tests that can both diagnose and treat at the same time. In other words, your gastroenterologist can detect early signs of colorectal cancer and remove precancerous polyps during the procedure. The removal of the polyps is known as a polypectomy. When a polypectomy is referred to as “complex,” that refers to a larger size or higher number of polyps in the colorectal area. If a polyp is considered to be complex, your doctor will likely schedule a complex polypectomy as opposed to removing the polyps during the standard colonoscopy.

What Are Complex Polyps?

About 10 to 15 percent of all polyps are complex. To be considered a complex polyp, it has to meet certain criteria, such as:

• There are a high number of large polyps
• Polyps are larger than 2cm
• The polyp is located in a hard-to-reach area
• When the physician another gastroenterologist with special skills or training or a surgeon should remove the polyp

The word “complex” typically refers to the size and location. Complex polyps can be benign, precancerous, or cancerous. If a complex polyp is benign, your healthcare provider may not opt for a complex polypectomy but a nonsurgical procedure instead. 

Colorectal polyps are common in adults, and it’s estimated that one in three adults has polyps in the colorectal area. Many polyps are benign, and if you have polyps, it does not necessarily mean they will progress to colon cancer. However, your gastroenterologist will remove most any polyp they find in the colon as a precaution.

How Are Complex Polyps Diagnosed?

Typically, the only way polyps are discovered is through a routine colonoscopy screening. A colonoscope is a long, thin tube with a small camera attached to it that is inserted through the anus and rectum and into the large intestine (colon). If your physician sees polyps that can be be safely removed, they will do so. If they see complex polyps (a type that would meet the above criteria), then your healthcare provider will diagnose complex polyps and most likely schedule you for a complex polypectomy.

How Do I Prepare for a Complex Polypectomy?

Just as with a typical colonoscopy, you will have to prepare for this procedure. You will have written instructions from your physician and will take laxatives to clear the colon the night before. You may have some abdominal cramping or discomfort, which it is fine to take acetaminophen for. If your large intestine is not completely clear, you’ll have to reschedule the procedure, so ensure you follow the instructions thoroughly.. 

While complex polypectomy is an outpatient procedure, you will be under anesthesia for the polypectomy, so make sure you have someone to drive you home. Typically, you can return to most normal activities the next day. 

Patients with certain medical conditions, such as diabetes, or patients that take certain medications, such as warfarin, should let their doctor know well in advance of the procedure.

What Happens During and After Complex Polypectomy?

During a complex polypectomy, your gastroenterologist (or surgeon, depending on the degree of difficulty) will have IV anesthesia administered to sedate you for the procedure. The doctor will then surgically remove the polyps. After the procedure, you’ll likely spend about 30 minutes in the recovery room and will be closely monitored by nurses. You are then discharged to home. Complications after colonoscopy with complex polypectomy is uncommon, but can occur given nature of procedure. They include bleeding and perforation, which is a deep tear or hole in the wall of the colon. 

What Are Other Ways to Remove Complex Polyps?

Complex polypectomy often requires special techniques and tools to remove a polyp during the colonoscopy. Your doctor may use one of two techniques listed below to remove complex polyps:

• Endoscopic mucosal resection (EMR). During this procedure, the gastroenterologist will inject fluid into the base of the polyp to lift it off the wall of the colon. This makes it easier and safer to cut and remove the polyp using standard wire snares, which are shaped like a lasso. Preparation for this procedure is similar to that of a typical colonoscopy.
• Endoscopic submucosal dissection (ESD). This treatment is very similar to that of EMR, as fluid is once again injected into the base of the polyp. Then your physician will use tiny cutting probes to carefully dissect the polyp off the wall of the colon. Again, you would prepare as if you were prepping for a colonoscopy. 

Who Should Be Screened for Colon Cancer?

The only way to detect complex polyps is to have a colonoscopy, the gold standard for colorectal cancer screening. The  American Cancer Society, US Preventive Services Task Force, and US  Mutli-Society Task Force on Colorectal Cancer have all recommended that both men and women should start screening for colorectal cancer at age 45. Those who are high risk (such as having a family history of polyps or colon cancer) should be screened earlier in most cases. Detecting precancerous cells or colon cancer in its early stages greatly increases the chances of recovery.