24/07/2026
Polypectomy: How a Polyp Is Removed During Colonoscopy
Discover how polypectomy is performed during colonoscopy, which techniques are used, and how colorectal cancer can be prevented through polyp removal.
18/06/2026
Published by Meditalia
Polypectomy is the procedure by which a gastroenterologist removes colorectal polyps directly during colonoscopy, transforming a diagnostic examination into a complete therapeutic intervention. It is one of the most frequently performed endoscopic procedures worldwide and the primary tool for the active prevention of colorectal cancer (CRC).
In Italy, colorectal cancer is the second most commonly diagnosed malignancy in the adult population, with approximately 49,000 new cases reported annually (AIOM 2023). The progression from adenomatous polyp to carcinoma takes an average of 10–15 years — a valuable therapeutic window during which endoscopic polypectomy can definitively interrupt the carcinogenetic process.
Understanding how polyp removal is performed during colonoscopy is relevant not only for gastroenterology professionals, but also for healthcare operators involved in patient preparation and post-procedural management. The European Society of Gastrointestinal Endoscopy (ESGE) provides regularly updated, evidence-based recommendations for every phase of the procedure.
What Is a Colorectal Polyp and Why Must It Be Removed
A polyp is an abnormal growth of the intestinal mucosa that protrudes into the colonic lumen. Not all polyps carry the same risk of malignant transformation: hyperplastic polyps are generally benign, whereas adenomas — particularly those with a villous component or high-grade dysplasia — are pre-malignant lesions that require removal.
The Paris classification describes polyp morphology based on their macroscopic profile: polypoid lesions (pedunculated Ip, sessile Is) and non-polypoid lesions (flat elevated IIa, depressed IIc). This distinction directly informs the choice of the most appropriate polypectomy technique.
Polyp size is another key parameter: lesions are categorised as diminutive (≤5 mm), small (6–9 mm), and large (≥10 mm), with specific technical indications for each category.
How Polypectomy Is Performed During Colonoscopy
The Identification Phase
The first step in polypectomy is the accurate identification of the lesion during colonoscopy. Modern high-definition video colonoscopes, combined with digital image enhancement technologies such as narrow-band imaging (NBI), FICE, and BLI, enable the detection of even flat and depressed lesions — historically the most difficult to visualise.
The endoscopist assesses the morphology, size, surface characteristics, and location of the lesion before selecting the most appropriate resection technique.
Cold Snare Polypectomy
For diminutive and small polyps (≤9 mm), the technique recommended by ESGE guidelines is cold snare polypectomy (CSP). A wire snare is positioned around the base of the polyp and closed mechanically, transecting the tissue without the application of electrical current.
The advantages of this technique include a lower risk of delayed post-procedural bleeding, absence of thermal injury to the intestinal wall, and shorter procedure times, with resection radicality comparable to conventional techniques for appropriately sized lesions.
Endoscopic Mucosal Resection (EMR)
For sessile polyps between 10 and 19 mm, the reference technique is endoscopic mucosal resection (EMR). Prior to resection, a lifting solution — typically saline, hyaluronic acid, or glycerol — is injected into the submucosal layer to elevate the polyp from the muscularis propria, creating a protective cushion that substantially reduces the risk of perforation during snare resection.
For large lesions (≥20 mm) that cannot be resected en bloc, EMR is performed in multiple fragments (piecemeal EMR), requiring a close endoscopic follow-up at 3–6 months to assess resection completeness.
Hot Snare Polypectomy for Pedunculated Polyps
Large pedunculated polyps are removed using hot snare polypectomy, applying a coagulation current to the stalk before transection. When the stalk diameter exceeds 10 mm, preventive placement of a detachable snare loop or intrastalk adrenaline injection is recommended to reduce the risk of immediate or delayed bleeding.
Endoscopic Submucosal Dissection (ESD)
Endoscopic submucosal dissection (ESD) is reserved for complex lesions: polyps ≥20 mm not amenable to en bloc resection by EMR, lesions with surface features suggestive of superficial submucosal invasion, and recurrent adenomas following prior polypectomy. It is an advanced technique requiring operators with a specific learning curve and dedicated tertiary referral centres.
What Happens After Polyp Removal
The resected tissue is retrieved using a net retrieval device or suction and sent for histopathological analysis. The pathology report — generally available within 7–14 days — determines the polyp type, degree of dysplasia, and resection radicality, guiding the subsequent surveillance programme.
According to the ESGE 2020 Post-Polypectomy Surveillance Guidelines, follow-up intervals range from 3–6 months (for piecemeal resection of large lesions) to 5–10 years (for single low-risk adenomas), depending on the histological characteristics of the resected lesion.
Managing Polypectomy Complications
Polypectomy is a safe procedure, but not entirely without risk. The main complications include:
Bleeding The most frequent complication, with an incidence below 1% for cold techniques and slightly higher for hot snare resections. Delayed bleeding — which may occur up to 14 days after the procedure — is managed endoscopically using haemostatic clips, adrenaline injection, or argon plasma coagulation.
Perforation Rare (0.1–0.5% in complex resections), but potentially serious. When recognised intra-procedurally, it can in most cases be treated endoscopically with clips, avoiding the need for surgical intervention.
Post-polypectomy syndrome A rare complication characterised by localised abdominal pain and fever within 24 hours of the procedure, in the absence of visible perforation. Management is conservative.
The Role of Medical Devices in Polypectomy
The technical quality of a polypectomy depends significantly on the endoscopic accessories employed. The single-use digestive endoscopy accessories distributed by Meditalia S.r.l. — cold and hot polypectomy snares, submucosal injection needles, haemostatic clips, and retrieval nets — are designed to meet the operational requirements of every resection technique, from the most straightforward to the most advanced.
The use of CE-certified single-use devices, in compliance with EU MDR Regulation 2017/745, ensures full traceability, eliminates the risk of cross-contamination between patients, and guarantees consistent, reproducible performance in every clinical setting. Meditalia supports digestive endoscopy centres with a comprehensive range of accessories compatible with the leading endoscopic systems on the market.
Conclusion & FAQ
Endoscopic polypectomy is a safe, effective, and clinically decisive procedure in the prevention of colorectal cancer. Selecting the most appropriate technique — from cold snaring for diminutive polyps to ESD for complex lesions — requires clinical expertise, advanced endoscopic technology, and reliable medical devices.
Meditalia S.r.l. supports gastroenterology professionals with certified accessories for every phase of the polypectomy procedure. Browse the product catalogue at meditaliagroup.net or contact our commercial team for dedicated technical support.
What is polypectomy and when is it performed?
Polypectomy is the endoscopic removal of colorectal polyps performed during colonoscopy. It is indicated whenever a polyp is identified during the examination, regardless of size, as even small lesions may carry long-term malignant potential.
Is polypectomy painful?
The procedure is performed under conscious or deep sedation, so the patient does not experience pain during polyp removal. Mild abdominal cramping may occur in the following hours and typically resolves spontaneously within 24 hours.
How long does polypectomy take?
Duration depends on the number and complexity of the lesions. Removal of a single diminutive polyp requires only a few minutes; EMR or ESD of large lesions may extend the colonoscopy by 30–60 minutes.
Is a special diet required after polypectomy?
Yes. In the 24–48 hours following the removal of large polyps or resections performed with hot techniques, a liquid or soft diet is recommended to reduce the risk of delayed bleeding. The gastroenterologist will provide personalised dietary instructions at discharge.
How frequently should colonoscopy be repeated after polypectomy?
The surveillance interval depends on the number, size, and histological characteristics of the resected polyps. According to ESGE 2020 guidelines, it ranges from 3–6 months (for piecemeal resection of large lesions) to 5–10 years (for single low-risk adenomas).
The content published in this section of the website is intended for informational and educational purposes only and is addressed to both healthcare professionals and the general public. While prepared with care and based on scientific evidence and guidelines available at the time of publication, the texts may contain errors, inaccuracies, or information that is not up to date with the most recent developments in the medical and scientific literature.
The content does not constitute medical advice, diagnosis, or treatment recommendations of any kind and does not replace the direct relationship between a patient and their treating physician. Meditalia S.r.l. accepts no liability for clinical decisions made on the basis of the information provided herein.
For any concerns regarding health conditions, diagnostic procedures, or treatments, please always consult a qualified physician or healthcare professional. To report possible inaccuracies in the content, please contact Meditalia S.r.l. through the channels listed in the Contacts section of the website.
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