Colonoscopic Polypectomy

What you should know

• Colonoscopic polypectomy is surgery to remove colorectal polyps. Colorectal polyps are small lumps of tissue in the lining of the colon and rectum. Some polyps, such as hyperplastic polyps, are usually benign (noncancerous) and may not cause any symptoms. Other polyps, such as adenomatous polyps, may develop into cancer (tumor). The colon and rectum are also called the large bowel. They are part of the digestive system in the lower part of the abdomen (stomach). The digestive system is where food is swallowed and broken down. The colon is the first section of the large bowel where stool (bowel movements) form. The rectum is the last part of the large bowel where stool stays before leaving the body.
  
  
• In a colonoscopic polypectomy, your caregiver uses a colonoscope, which is a soft, bendable tube with a light and tiny camera on the end. Special tools may be passed through a channel (tunnel) in the colonoscope to remove polyps. How colorectal polyps will be removed depends on the type, shape, size, and location of the polyps. They may be removed by snaring (lassoing them) with a wire loop that cuts and burns them off. If they are small, they may just be burned off. Polyps may be removed one tiny piece at a time if they are large, or in one piece if they are small. With colonoscopic polypectomy, colorectal polyps may be removed, your symptoms relieved, and colorectal cancer may be prevented.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

Risks

• A colonoscopic polypectomy carries certain risks. You may have a slow heartbeat, decreased blood pressure, increased sweating, or faint (pass out). You may have pain or bleeding as the scope is passed inside your colon and after your surgery. You may have bleeding or a burn on the wall of your colon from the removal of your polyps. Your colon may be perforated (torn) due to the increased pressure from the scope or from the instruments used. This may cause bowel contents to leak out of the colon and into your abdomen. If this happens, you will need to stay in the hospital and have surgery on your colon. Following your caregiver's advice during and after the surgery may decrease your chances of having any problems.
  
  
• Without this surgery, your signs and symptoms may continue and worsen. Colorectal polyps may not be removed and may develop into cancer, which may cause problems that are more serious. Ask your caregiver if you are worried or have questions about your surgery, medicine, or care.

Getting Ready

The week before your surgery:

• Ask a family member or friend to drive you home after your surgery. Do not drive yourself home.
  
  
• Ask your caregiver if you need to stop using any of your present medicines. If you take aspirin, ibuprofen, or blood thinners, do not stop taking them without first asking your caregiver.
  
  
• Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine. Tell your caregiver if you use any herbs, food supplements, or over-the-counter medicine.
  
  
• Dye may be used during your surgery to help caregivers mark the spot where they found your polyp. Tell your caregiver if you are allergic to any dye.
  
  
• If you have diabetes, ask your caregiver for special instructions about what you may eat and drink before your surgery. If you use medicine to treat diabetes, your caregiver may have special instructions about using it before surgery. You may need to check your blood sugar more often before and after having surgery.
  
  
• Tell your caregiver if you have an implanted pacemaker or a special device for your heart.
  
  
• Tell your caregiver if you have other diseases, such as severe (bad) inflammation of the bowel or kidney problems. Certain medicines used to empty your bowel may not be good for you.
  
  
• If you are female, tell your caregiver if you know or think you might be pregnant.
  
  
• You may need to have blood, urine, or other tests. Ask your caregiver for more information about these tests. Write down the date, time, and location of each test.
  
  
• Ask caregivers about directions for eating and drinking.
  
  
  • A clear liquid diet or a diet that helps to clean out your colon may be started 1 to 4 days before your surgery. Clear liquids may include plain gelatin, unsweetened fruit juices, clear soup, or broth.
    
    
  • Do not eat foods with residue or fiber that are not easy to digest. These include fruits, vegetables, cereal, nuts, peas, beans, fried foods, and bread.
    
    
  • Increase the amount of water you are drinking. Make sure you drink 8 to 10 (eight-ounce) cups of liquid, especially on the day before your surgery.

The day before your surgery:

Your bowel needs to be empty before your surgery. This will help the scope to pass through your colon easier and help your caregiver better see your polyps. Your caregiver may tell you to take a cathartic (laxative). These medicines may give you diarrhea (loose, watery stools), but will quickly clean out your bowel.

The night before your surgery:

• Ask caregivers about directions for eating and drinking.
  
  
• Bowel preparation: You will need to clean out your colon to get ready for this surgery. Your caregiver may ask you to do one or more of the following:
  
  
  • Aside from the laxative, you may need a liquid medicine called an enema. An enema uses warm water that is put into your rectum (rear end) to help empty your bowel. The directions should be on the package. Your caregiver may also teach you how to do this.
    
    
  • You may be given 8 to 12 cups (8-ounce cups) of special bowel prep medicine to drink. Drink one 8-ounce cup of bowel prep medicine every 10 minutes until you are passing clear fluid. Ask your caregiver for more information about this medicine.

The day of your surgery:

• Bowel preparation:
  
  
  • Do not eat or drink anything on the morning of your surgery. The images may not be seen clearly if your colon is not totally empty.
    
    
  • You may need an additional enema, using warm water, the morning of your surgery.
    
    
  • You may also be asked to drink an additional 4 to 8 cups (8-ounce cups) of the special bowel prep medicine. This may be done if you drank the bowel prep medicine the night before.
  
  
• Ask your caregiver before taking any medicine on the day of your surgery. These medicines include insulin, diabetic pills, high blood pressure pills, or heart pills. Bring all the medicines you are taking, including the pill bottles, with you to the hospital.
  
  
• Do not wear tight-fitting clothes on the day of your procedure or surgery.
  
  
• IV: An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  
  
• You or a close family member will be asked to sign a legal piece of paper (consent form). It gives your caregiver permission to do the surgery. It also explains the problems that may happen and your choices. Be sure all your questions have been answered before you sign this form.

Treatment

What will happen:

• You will be taken on a stretcher to the colonoscopy room and then moved onto a special bed or table. You will be given medicine to help you relax, especially if you feel anxious or nervous. You will be asked to lie on your left side and raise one or both knees toward your chest. Your lower body will be covered with a sheet. Your caregiver will examine your anus (rear end) and use a finger to perform a digital rectal exam to check your rectum. He may feel for your prostate if you are a male. If your bowel is not totally empty, your caregiver may give you another enema.
  
  
• During your surgery, the colonoscope will be lubricated with jelly and gently placed into your anus. It will then be passed through the rectum and into the colon. Your caregiver may inject fluid under the polyp or use dye to mark it to make it easier to remove. He may pass a snare (wire loop) through the colonoscope and use it to lasso the polyp. The polyp will then be burned or cut off of the wall of the colon. Small, special tools may also be used to burn or cut the polyp off the wall of the colon. The polyps that are removed will be sent to a lab for tests. Your caregiver may videotape or take pictures of the inside of your colon while doing the surgery. When the surgery is finished, the scope will be slowly removed and your anus will be wiped with gauze.

After your surgery:

You may lie in bed and rest for a while since the surgery may be a little tiring. You may pass some air that may be left in your colon. You may see blood in your bowel movement (BM) from the removal of your polyps. When your caregiver sees that you are OK, you will be allowed to change clothes and go home. You will need someone to drive you home if you were given medicine to relax you. Do not drive home alone. If your caregiver wants you to stay in the hospital, you will be taken back to your hospital room.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

• You cannot make it to your appointment on time.
  
  
• You have a fever.
  
  
• You have constipation (dry, hard stools) and the medicines are not helping to empty your bowel.
  
  
• You have questions or concerns about your surgery.

Seek Care Immediately if

• You are not able to eat or drink, or are urinating less or not at all.
  
  
• You have blood in your bowel movement (BM).
  
  
• You are unable to have a BM.
  
  
• Your abdomen becomes tender and hard.

Copyright © 2012. Thomson Reuters. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.