Polypectomy & EMR

A polypectomy — the removal of a polyp (a small growth on the lining of your bowel) — is performed while you are comfortably sedated during your colonoscopy. You will not feel a thing.

For smaller polyps, either a wire loop (called a snare, which tightens around the base of the polyp and removes it cleanly) or tiny forceps is used. For larger or flat polyps that sit close to the bowel wall and cannot be safely removed by snare alone, a technique called EMR — endoscopic mucosal resection — is used. In EMR, a small amount of fluid is injected underneath the polyp to lift it gently away from the deeper bowel wall, creating a safe cushion, and the snare then removes it in one or more pieces. Both approaches are done entirely through the scope itself — no cuts to your skin, no stitches, and no separate operation needed.

Polyp removal is recommended when any of the following apply:

• You have an adenomatous polyp (a type of polyp that, if left alone, can slowly turn into bowel cancer over many years) of any size — removing it now breaks that chain entirely
• You have a sessile serrated lesion — a flat, carpet-like growth that looks different from a standard adenoma but also carries a small cancer risk over time
• You have a large or flat polyp that cannot be removed safely with a standard snare alone, making the EMR technique the right approach
• A follow-up colonoscopy has found new polyps growing in the same area that was previously treated
• A prior procedure removed a polyp but left a small amount of residual tissue that now needs to be fully cleared
• The most straightforward reason: removing the polyp now prevents any possibility of it ever turning into bowel cancer

• The polyp is removed before it has any chance to become cancer — that is the most important outcome of this procedure, and it is a reassuring one. Most polyps never would have caused you harm, but removing them means you do not have to wonder
• It is usually done during the same colonoscopy — in most cases, the polyp is removed in the same sitting as it was found. You are not asked to come back for a second procedure on a separate day
• Even large polyps can be removed this way — polyps that would once have required open surgery can now often be removed safely and completely through the colonoscope, with no cuts to your skin and no overnight hospital stay
• You go home the same day — usually within a couple of hours of waking up from sedation
• High success rate — in published series, complete (R0) removal for EMR is achieved in around 75–95% of cases depending on lesion size; smaller polyps sit at the higher end of that range
• The tissue is examined afterwards — the removed polyp is sent to a pathology laboratory where a specialist examines the cells under a microscope (called histology). This tells us exactly what type of polyp it was, whether it was completely removed, and how often you need a follow-up colonoscopy in the future

This procedure has a well-established safety record, but no procedure is without risk. The following list is here so you know what to watch for — not to alarm you. Most people have their procedure and go home without any problems at all.

• Bleeding — the most common complication, happening in roughly 1 to 2 in every 100 cases. Most bleeding either stops on its own or can be managed through the colonoscope at the time, without surgery. It is also worth knowing that bleeding can occasionally start a few days after the procedure rather than immediately — this is called delayed bleeding, and it can occur up to two weeks later. If you notice a heavy or persistent amount of fresh blood from your back passage, call the rooms straight away. A small amount of blood-tinged stool in the day or two after removal is more common and usually nothing to worry about.
• Perforation (a small tear in the bowel wall) — uncommon but possible, particularly when removing large flat polyps. The risk is roughly 0.5 to 1.5 in every 100 large EMR procedures — lower for smaller, simpler removals. To reduce this risk, small metal clips are routinely placed at the end of the procedure to close the treated area. If perforation does occur, it is identified and treated promptly; in the rare cases where it cannot be managed conservatively, a short hospital stay or further treatment may be needed.
• Incomplete removal — occasionally a very large or complex polyp cannot be fully removed in a single sitting. If this happens, a follow-up colonoscopy is arranged at around 3 to 6 months to check the site and remove any remaining tissue. This is not a failure — it is simply the safest approach when a polyp is particularly challenging.
• Post-polypectomy syndrome — a small number of people (fewer than 1 in 100) experience some abdominal discomfort and a mild temperature in the day or two after a large EMR. This is caused by localised inflammation at the treatment site rather than a tear in the bowel wall, and it usually settles with rest, fluids, and simple pain relief. If you are worried, call our rooms and we will advise you.
• Sedation side effects — nausea, grogginess, or a mild sore throat are common and brief. Serious reactions to sedation are rare, and the team is trained to manage them if they occur.

The preparation for polypectomy and EMR is exactly the same as for the colonoscopy (or flexible sigmoidoscopy) itself — bowel preparation, fasting, and medication adjustments. Please follow the instructions on the procedure page you have been booked for; there are no extra steps for the polypectomy itself.

The one thing worth flagging early: if you take blood thinners (such as warfarin, apixaban, rivaroxaban, clopidogrel, or daily aspirin) or have any bleeding tendency, please let the team know when you book. Removing a polyp carries a small risk of bleeding, so these medications often need to be paused or adjusted in advance. A plan is worked out with you and your GP so you remain safely covered.

The arrival, sedation, and recovery elements of the day are exactly as described on the Colonoscopy or Flexible Sigmoidoscopy pages. The polypectomy-specific steps, which happen during the procedure itself, are:

• When a polyp is reached, its size, shape, and position are assessed carefully before deciding the safest way to remove it.
• Smaller polyps are removed using a wire snare — a tiny loop that tightens around the base of the polyp — or small forceps. This is quick and straightforward.
• Larger or flat polyps are treated with EMR: a small volume of fluid is injected beneath the polyp to lift it safely away from the deeper bowel wall, creating a cushion of space. The snare then removes the polyp in one or more pieces.
• Once each polyp is removed, the base is inspected carefully, and small metal clips or a brief heat treatment (called coagulation) may be applied to seal the area — this reduces the risk of bleeding and helps the site heal cleanly.
• The removed polyp tissue is sent to a pathology laboratory for examination under the microscope (called histology).

You then wake up in the recovery area as you would after any colonoscopy. Before you leave, you will be given written aftercare instructions specific to the polypectomy — including the points in the next section.

• The day of your procedure — go home and rest: Go straight home, take it easy, and let the sedation wear off fully. You cannot drive for the full 24 hours after sedation, even if you feel perfectly clear-headed — this is a firm safety rule. Have your responsible adult with you at home. You can eat and drink normally once you feel alert.
• Days 1 and 2 — take it gently: Stick to light, easy-to-digest foods — toast, soup, crackers, yoghurt, rice. Avoid alcohol for at least 24 hours. Avoid anti-inflammatory pain tablets such as ibuprofen or naproxen (called NSAIDs — non-steroidal anti-inflammatory drugs) for one week, as these can increase the risk of bleeding from the treated site. Paracetamol is fine if you need pain relief. Avoid heavy lifting or strenuous exercise.
• Day 3 onwards — easing back to normal: Most people feel completely back to their usual selves by day 3 and can gradually return to all normal activities. Follow your body's lead — if something feels uncomfortable, hold off a little longer.
• Watching for delayed bleeding — stay alert for two weeks: A small amount of blood in the toilet or on the paper in the first day or two is not unusual, especially if a large polyp was removed. If you notice a heavier or persistent amount of fresh red blood, call the rooms straight away. Keep an eye on this for the full two weeks after your procedure — delayed bleeding is uncommon but possible during this window, even if everything seemed fine initially.
• When to seek urgent help — do not wait: If you develop severe or rapidly worsening abdominal pain, a high fever, or heavy bleeding that does not settle, do not call the rooms and wait — go straight to the emergency department or call 000. These symptoms are rare, but they need immediate assessment.
• Your pathology results: The removed polyp tissue is sent to a laboratory and examined by a pathologist (these are called histology results). The rooms will contact you within two to three weeks to discuss what was found and what it means for your follow-up plan.
• Future follow-up colonoscopies: The type and number of polyps removed determines how often you will need a surveillance colonoscopy in the future — this is typically somewhere between 1 and 5 years. A personalised recommendation, based on your specific results, will be given to you. This is not a lifetime sentence of constant procedures — it is a sensible, evidence-based schedule to keep you safe.
• Your post-procedure review: A review is routinely arranged 2 to 6 weeks after your procedure to go through the findings, your pathology results, and any next steps. For straightforward follow-up this is typically offered as a telehealth review at no charge; an in-person review (for example, to plan further treatment) attracts a standard consultation fee.

Questions or concerns after your procedure? Please call our rooms on (03) 9816 3951 and leave a message — it will be sent directly to Mr Nguyen as a text. You can also text the office mobile on 0499 090 126. We aim to get back to you promptly during business hours. Please do not hesitate — it is always better to check.

For anything urgent: If you have severe or rapidly worsening abdominal pain, heavy bleeding, or you feel seriously unwell, call 000 immediately or go straight to your nearest emergency department — do not wait to hear back from us. Austin Hospital Emergency Department: (03) 9496 5000.