Polypectomy: repeated colonoscopies are not necessary

For a successful polypectomy, a good colonoscopy is the key. The procedure should only require one colonoscopy, but many undergo several. Improvement is much needed.

Great potential for improvement in colonoscopies

Qualitative colonoscopies: why are they so important?

Colonoscopies are part of the daily routine of almost all gastroenterologists. While it may be sufficient for a normal check-up without any conspicuous findings if the person's intestine is not quite ideally prepared, the situation is different for existing or newly discovered polyps.

The goal here is the complete removal of the polyp in one session. For this, it is absolutely necessary that the patient cleans the bowel well, but also that the examiner is well prepared and trained. Unfortunately, a second or even third colonoscopy is often necessary for a polypectomy.

Why are multiple iterations necessary?

It is obvious that this scenario should be avoided. Not only is the examination often unpleasant for those affected and - like all interventions - associated with certain risks. The costs incurred by repeated examinations are also not to be neglected.

A recent study investigated through a European comparison how frequent such second procedures are and why they become necessary: Up to 10% of people with high-risk polyps have to undergo two or more colonoscopies. The main reasons for this are considered to be inadequate bowel preparation and incomplete resection of the polyp.

What can be improved in colonoscopy?

The study authors state that the quality of colonoscopies varies from medical centre to medical centre. However, it is important that endoscopy practices investigate why repeat examinations occur. 

For example, training the staff, but also better education for the patients can possibly reduce the problem significantly. Regular maintenance of the equipment also plays a major role.

Recommendation: Identify causes and take action

Repeating colonoscopies for polypectomy should be avoided. To this end, it is important for examiners to recognise why multiple colonoscopies occur in their practices or centres. Only then can appropriate measures be taken to achieve high-quality procedures at the first attempt.