Endoscopic Polypectomy: Surgical Removal of Polyps
Procedure · Silo Endoscopy · Colombia 2026
Endoscopic polypectomy: removal of polyps during colonoscopy without surgery
Endoscopic polypectomy is the procedure that makes colonoscopy the only screening tool that prevents colorectal cancer—removing the polyp before it becomes malignant, without a single incision
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GSMED Imaging medical team—therapeutic endoscopy Colombia
Based on: ESGE Guideline on Polypectomy 2023, USMSTF Guidelines on Colorectal Cancer Screening 2024, van Doorn 2024 meta-analysis, and advanced polypectomy practice in Colombia.
Colorectal cancer takes 10–15 years to develop from a benign adenomatous polyp. That time is exactly the window colonoscopy has to act: detect the polyp in its benign phase and remove it during the same procedure—before it has the chance to become cancer. Endoscopic polypectomy is the reason colonoscopy reduces colorectal cancer mortality.
1. Types of colon polyps and their risk
| Polyp type | Histology | Risk of malignancy | Management |
|---|---|---|---|
| Hyperplastic polyp | Hyperplastic (non-neoplastic) | Almost zero—small recto-sigmoid hyperplastic polyps are minimum risk | Remove to confirm histology. Does not change the surveillance interval. |
| Tubular adenoma | Neoplastic—the most common (80%) | Low if <1 cm without high-grade dysplasia · Moderate if >1 cm | Always remove · Surveillance colonoscopy at 3–5 years |
| Villous / tubulovillous adenoma | Neoplastic—larger villous component | Higher than tubular · Pure villous reaches 40% malignancy if >2 cm | Always remove · More frequent surveillance |
| Adenoma with high-grade dysplasia | Neoplastic—close to carcinoma in situ | Very high—at the border with intramucosal cancer | Remove with confirmed clear margins · EMR or ESD if flat |
| Sessile serrated lesion (SSL) | Serrated—distinct epigenetics from conventional adenoma | Moderate-high especially if >1 cm with dysplasia | Remove en bloc · Surveillance at 1–3 years |
2. Polypectomy techniques—which one is used depending on the polyp
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Cold snare
The mechanical snare cuts the polyp without electric current—only by mechanical pressure. The standard for 1–9 mm polyps according to ESGE 2023. Lower risk of delayed bleeding than the hot snare. Faster. The polyp must always be retrieved for histological analysis.
→ 1–9 mm · No electricity · Less delayed bleeding · ESGE standard
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Hot snare
The snare cuts the tissue by applying high-frequency electric current (ERBE or ESG generator) that simultaneously coagulates the vessels—integrated hemostasis. For pedunculated polyps with a thick stalk (>5 mm stalk diameter) where the risk of stalk bleeding is higher. Requires a high-frequency generator.
→ Thick stalk · Large pedunculated · Simultaneous coagulation
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Mucosectomy (EMR)
Endoscopic Mucosal Resection—for flat or sessile polyps of 10–20 mm. A submucosal solution (saline + epinephrine + dye) is injected to lift the lesion, then it is captured with the snare and resected en bloc or in fragments. Allows treating lesions that the simple snare would not capture.
→ Flat 10–20 mm · Prior submucosal injection · En bloc or fragments
3. ESD—Endoscopic Submucosal Dissection—the advanced technique
ESD: the technological leap that changed advanced therapeutic endoscopy
ESD (Endoscopic Submucosal Dissection) allows resecting in a single fragment—regardless of size—large flat lesions (≥20 mm), lesions with scar fibrosis that do not lift well with injection, and superficial neoplasms of risk without submucosal invasion. Unlike EMR, which resects the mucosa in several fragments (limiting margin evaluation), ESD provides a single surgical piece that the pathologist can evaluate with measurable margins. It is the technique that most resembles oncological surgery in its precision—without an incision. It requires a high-end therapeutic endoscope (Olympus EVIS X1 or EVIS EXERA III), ESD knife, ERBE generator, and an endoscopist with specific training of at least 2–3 years.
How often should I repeat the colonoscopy after they removed a polyp?
The surveillance colonoscopy interval depends on the type and size of the removed polyp. USMSTF 2024 guidelines: 1 small hyperplastic polyp in the recto-sigmoid: return to standard screening (10 years); 1–2 tubular adenomas <10 mm without high-grade dysplasia: surveillance at 7–10 years; 3–4 adenomas or 1 adenoma ≥10 mm: surveillance at 3 years; ≥5 adenomas or adenoma ≥20 mm: surveillance at 1 year; Adenoma with high-grade dysplasia or ESD: surveillance at 3–6 months to check margins. Your gastroenterologist will tell you the exact interval according to your case and the pathologist's histology.
Equipment for polypectomy and ESD available in Colombia—GSMED
Therapeutic Olympus colonoscopes, ERBE generators, and snares for polypectomy—authorized distributors with local technical support.
Related articles
Sources
- ESGE. Guideline: Endoscopic management of colorectal polyps. esge.com. 2023. Cold snare, EMR, ESD. ESGE 2023
- USMSTF. Colorectal Cancer Screening Guidelines. 2024. Post-polypectomy intervals. USMSTF 2024
- van Doorn SC et al. Cold snare polypectomy vs hot snare. Endoscopy. 2024. van Doorn 2024
