Retrieve That Tumor!

Polyps have recently made GI headlines, with two reports highlighting the importance of capturing the abnormalities before they develop into cancerous adenomas.

Amnon Sonnenberg, MD at the Department of Veterans Affairs Medical Center in Albuquerque, New Mexico led a team of researchers in determining the most effective method of preventing colorectal cancer. The group found a colonoscopy procedure every 10 years is more beneficial than asprin-therapy or other combined methods in discovering pre-cancerous polyps. The early detection significantly increases a patient's survival rate.¹

A second study from Hopital Antoine Beclere in Clamart, France, reports patients who drink alcohol excessively may be pushing their polyps to prematurely develop into high-risk adenomas. The team discovered heavy drinkers were more likely to develop these pre-cancerous polyps and cancer than those who had a family history of the disease.²

Polyps, or bowel lining protrusions, are tumors characterized with a pedicle. This stem-like branch of the tumor can help the abnormal cell growth attach itself to a variety of areas within the body. There are polyps of heart, cervix, ear, etc... However, for those working in the endoscopy suite, colorectal polyps are public enemy No. 1. These small tumors are often the precursor of cancer and other serious gastrointestinal disease.

Removing these growths is not difficult, but getting them to pathology can often be challenging.

The colonoscopic snare polypectomy was introduced in the 1970s in the US.³ Physicians use a polypectomy snare tool to quickly send an electric current to the site of the growth, detaching from the wall of the bowel. After the polyp is loose, it must be retrieved for analysis. The physician can either use a specific retrieval device designed to work with the snare, or withdraw the snare from the endoscope and push in a net to retrieve the polyp. The tumor is then sent to pathology for testing.

Allison Hansen, marketing manager at US Endoscopy Group, describes the difference in these techniques.

"The polyp is already exiced by a standard polypectomy snare. Then you pull that snare out," she said. "Then, you push the net down the biopsy channel and use this as a separate retrieval device."

However, there is a simplified version of this procedure that decreases the chance of losing the polyp. The Nakao-snare, developed by Naomi Nakao, MD, of New York, combines the snare and the net.

"It is a dual lumen device. Out of one side of the lumen comes the standard polypectomy snare. As you are visualizing your polyp, you can cut it off," Hansen said. "Then you pull the snare back in, and there is a part on the handle where you push out the net. While you are right there, you can capture the polyp."

With this single device, the procedure time is shortened and the polyp is retrieved without being macerated. It can be sent in tact to pathology.

Wendy Tyson, LPN, said her endoscopy team at Tiftarea Endoscopy Center in Tifton, Georgia handles 7-10 procedures a day. She estimates half involve removing polyps and notes that while the procedure is common, extreme care must be used in each case to prevent complications.

"I would say in every 2 out of 4 procedures we remove polyps. We have different methods. We can use a biopsy forceps, a snare, or if it is difficult to retrieve, we use a net or a tripod," she said. "It is not a difficult procedure if you know what you are doing, but it has the potential of turning into something difficult. You have to be cautious to prevent perforation of the intestinal wall, bleeding, etc..."

Ron Townsend, RN, at the University of Arizona Medical Center, said his endoscopy team removes polyps 4-5 times daily. However, Townsend said he has a preferred tool when retrieving polyps.

"Depending on the size of the polyp, we generally used a tripod. The reusable tool fits through the scope and the doctor opens it. When it opens, it looks like a chicken's foot," he said, describing the triple-pronged tool. "When you open it, it has these three wires. It pushes up on the polyp and you bring it to the suction area of the scope. They'll suck the polyp through the trap into the canister."

According to officials at the National Institutes of Health (NIH), colon and rectal cancers are the most common cancers found in Americans aged 50 or older. With increased Medicare coverage of endoscopic procedures, this targeted group of people will be requesting more information about polyps--a potential precursor to cancer. Having the right arsenal of polyp removal and retrieval tools will help endoscopy suites fight these precancerous tumors and keep their patients healthy.

For a complete list of references and additional information concerning polyp removal and retrieval, log onto: www.endonurse.com.