I am an advanced endoscopist, and have been involved in complex and difficult procedures throughout my 26 years in practice. I perform over 500 polypectomy procedures per year, and I have trained over 50 advanced endoscopists in my career. I am considered an international expert on many aspects of endoscopy, including submucosal resection of lesions in the lower and upper gasrtointestinal tract.
The “Target Sign” is a descriptive term that suggests a possible breach of the colon’s outer muscle layer with a heightened risk of perforation. To avoid the risk of resulting infections, such as sepsis and peritonitis, it is standard care to closely examine the polypectomy site post procedure. The examiner should look for 1) residual polyp tissue that may remain, 2) risk of bleeding at the polypectomy site and 3) risk of injury to the outer muscle layer. If a potential risk is recognized, it is customary to place clips to close the defect, if possible. Occasionally, the defect is so large that clips may not be sufficient to prevent a perforation.
Whether or not to admit the patient for observation and or obtain post-polypectomy imaging depends on the clinical concern of a perforation as well as the post-procedure recovery evaluation. Post-procedure, nursing staff must monitor several parameters– including vital signs and pain level–to ensure the patient is safe and ready for discharge. If the Endoscopist is confident the defect has been successfully closed, it is proper to discharge the patient after an appropriate observation period. A review of the records is necessary to determine if sufficient evidence mandated overnight observation and or CT Imaging along with surgical consultation. Not all perforations require surgery. Some are managed by withholding food, antibiotics, and close monitoring.
