Grabber to pluck out nasty bowel growths — no op needed

UP TO one in five adults over the age of 50 has bowel polyps — small growths on the lining of the colon which can become cancerous if left untreated. Allan Smith, 77, a retired motor company worker, underwent a new procedure to remove one, he tells CHLOE LAMBERT.

THE PATIENT

WHEN my polyp was first detected, I had been suffering with breathlessness. I saw my GP and he diagnosed anaemia — low iron, causing a reduction in red blood cells — and gave me iron tablets.

But the problem continued and so, in June last year, I was referred for a colonoscopy.

This is where doctors insert a camera on a flexible tube into the back passage to examine the bowel and find out what’s going on.

They found a polyp, quite a long way inside. The doctors explained that these growths were fairly common and were associated with ageing.

They can become cancerous if left untreated, so t hey must be removed. My polyp was probably causing the anaemia, as polyps can leak blood — although I hadn’t noticed any.

The doctor took a biopsy which, when the results came back a week later, confirmed it wasn’t cancerous. Four months later, I had a nother colonoscopy where they tried to remove the rest of the polyp.

They took some out, but the consultant decided that because it was quite big (2cm), I needed to have a more specialist procedure.

We moved house and I was referred to a consultant gastroenterologist who took over my treatment.

He did a colonoscopy, and said the area around the polyp had become quite scarred from the attempt to remove it.

Scarring makes polyps trickier to remove, so there was a danger that by trying to cut it out, the bowel would be punctured.

But he said I would be suitable for a new procedure, using a device that grabs the polyp and pulls it out, like those fairground claw machines where you try to grab a cuddly toy.

This was instead of the old method which was more like a noose that cuts it off. Dr Boger said this new technique meant they could remove the polyp and avoid the need for major surgery.

I had the procedure last April. The most unpleasant part is you have to take some disgusting powders the day before, to clear your bowel. And I couldn’t eat anything for 24 hours.

On the day of the procedure I was given a sedative, and 45 minutes later it was all done.

I wasn’t conscious of what was going on, and afterwards it wasn’t painful. I just felt a bit weak.

I’m having a colonoscopy soon to check all is well, but I feel fine. At my last blood test there was no sign of anaemia, so I’m off the iron tablets. The breathlessness has improved and, now the cancer risk has been removed, it’s put my mind at rest.

THE SPECIALIST

DR PHILIP BOGER is a consultant in gastroenterology and advanced endoscopy at Southampton General Hospital

Polyps are growths developing on the intestine, most commonly in the large bowel or colon.

They are like lumps and bumps on the skin, but when they occur in the colon, they are a precursor to cancer.

There is a tendency for polyps to run in families. It’s difficult to know which polyps will turn cancerous, but there are certain risks — for example, a larger polyp means it’s more likely.

Polyps are often symptomless, but they do cause bleeding, so some people will notice blood in their stools.

They may become anaemic because of the lost blood and feel tired and out of breath — this is because there are fewer red blood cells carrying oxygen around the body. Sometimes polyps can cause the bowel habit to go a bit looser. We are picking up more bowel polyps as part of the national bowel cancer screening programme. Testing kits, sent to people aged 60 to 69, can detect traces of blood not visible to the eye. When we suspect a person has a polyp, because of symptoms or an abnormal screening result, they’ll be referred for an examination using a colonoscope.

If one is found, the aim is always to remove it.

Most polyps can be removed during the colonoscopy — normally we pass a wire through the colonoscope and loop it round the growth, like a lasso.

We can also attach tiny needles to the colonoscope to cut it off that way. When removing a polyp, it’s very important to avoid puncturing the bowel lining, which is just millimetres wide. Puncturing it could lead to matter spreading through the hole and causing an infection.

This would require emergency surgery and antibiotics. The risk of this is about one in 400. The bigger the polyp, the greater the perforation risk. And sometimes the nature of the polyp or its location also means the risk is higher.

If there is scarring around the polyp, for example — perhaps from previous attempts to remove it — it can be difficult to cut it out because scar tissue is tougher, tethering the growth to the underlying muscle tissue. The wireless lasso and other devices can only really tackle cells growing above the skin, but some polyps grow beneath the surface of the bowel lining.

In these cases, the patient usually faces abdominal surgery, which is much more invasive, requiring a general anaesthetic and a hospital stay.

There is a risk of leaking from the site of the bowel where we join it together, and if this occurs patients often have to return to theatre to have a colostomy bag placed.

For some patients, especially elderly people, surgery is not an option as it’s too risky.

But this year I began performing a new technique pioneered in Germany, using a device called a full-thickness resection device.

This can reach scarred polyps or polyps growing below the skin without damaging the lining of the bowel.

This procedure might, rarely, be used for a very early cancer, too, but it’s not really designed for that.

The procedure takes about 45 minutes and is done under sedation. As we remove the polyp, we seal the incision, so there’s minimal risk of infection.

We use a cap that fits on to the end of the colonoscope with a tiny grabber inside, and a tiny clip, about 2cm in size.

Once we’ve reached the site of the polyp, we use the grabber to pull the polyp up into the cap. Then we release the clip, which cuts the growth and is left in place like a staple, sealing the wound. The staple falls out one or two months later, as the bowel lining heals, and is passed out of the body painlessly in the stools. The patient should be able to go home the day of the procedure — there’s no pain, as the inside of the bowel has no nerve endings.

We’ll do a colonoscopy three to five months later to check there are no signs of the polyp. Once you’ve had a polyp, you’re more likely to get one in the future, so patients will be screened annually.

This procedure marks a milestone in enabling us to remove polyps — and, in turn, the risk of bowel cancer — without the need for major abdominal surgery.

It’s more cost-effective to perform than surgery, too, with a saving of €4,000 to €5,000 per patient when compared with surgery.

ANY DRAWBACKS?

‘There are certain polyps which gastroenterologists find very difficult to treat endoscopically — that is, through a flexible tube inserted in a small opening,’ says Colin Elton, a colorectal surgeon specialising in endoscopic techniques.

‘Techniques such as this mean we can remove the polyp without the need for surgery, although there will still be cases where surgery is most appropriate.

‘But it’s certainly an advance and is minimally invasive.

‘I’m always in favour of anything that helps patients avoid the operating theatre.’