Case Study: Using Telemedicine Prior to Surgical Removal of a Colon Polyp

A 62-year-old male underwent successful removal of a large colon polyp at UPMC Presbyterian in Pittsburgh, Pa. The polyp was found during a colonoscopy performed by Howard Black, MD, a colorectal surgeon at UPMC Bedford.

After viewing the results, Dr. Black referred the patient to David Medich, MD, FACS, FASCRS, chief, UPMC Division of Colon and Rectal Surgery, because the morbidly obese patient was high risk because of his size and other factors. The UPMC Division of Colon and Rectal Surgery is known to treat complex, high-risk colorectal cases. The patient, whose father had colon cancer, showed no signs of cancer symptoms prior to his colonoscopy.

“Because of family history, the patient knew he was high risk, and he sought out a colonoscopy to screen himself for colon cancer,” says Dr. Medich. “He was identified as somebody with an imminent cancer because he had a very large polyp that was found through the colonoscopy. In this case, the patient did not have cancer yet, but if he did not have the polyp removed, it would likely turn into cancer later.”

According to Dr. Medich, colon polyps are growths in the colon that are on the continuum and range from normal to precancerous to cancerous. “This a process that usually takes about seven to 10 years,” says Dr. Medich. “This is why we recommend a colonoscopy, because if polyps are found, a patient can have them removed before they become cancerous.”

Since the patient was morbidly obese, Dr. Medich decided it was best for the patient to lose weight prior to surgery. Losing weight before surgery can improve surgical outcomes and reduce the risk of complications, such as infection, blood clots, and heart attack.

“This is a case that was a little bit different because once the polyp was identified, it was so large that it could not be safely removed by endoscopic means, meaning that he required surgery,” says Dr. Medich. “Since the patient didn’t have cancer yet, there was not an immediate urgency to remove the polyp right away. We came to the decision with his primary care provider to have the patient lose weight to improve the surgery outcome.”

The patient was from Breezewood, Pa., which is two hours from Pittsburgh, and he utilized three telemedicine visits starting in November 2023 with Dr. Medich prior to his surgery in August 2024. Upon the first telemedicine visit, Dr. Medich recommended the patient lose weight prior to the surgery. The patient worked alongside his primary care provider to create a care plan to lose weight, where he was prescribed an antidiabetic medication used for the treatment of type 2 diabetes and for weight loss, along with changes to diet and exercise. With this care plan, the patient lost 90 pounds prior to surgery.

The total telemedicine pathway established by the UPMC Division of Colon and Rectal Surgery promotes the use of video visits for consultations, preoperative patient evaluations, and postoperative follow up. Using the portal provided by the MyUPMC app, a new patient engages with the surgeon via video conferencing from a location of the patient’s choosing, typically home or work.

“The use of the total telemedicine pathway takes this case to a whole new level,” says Dr. Medich. “We were able to monitor the patient’s progress working on his modifiable medical problem through telemedicine, such that he improved his chances for a better surgical outcome. His operation couldn’t have gone any better.”

The patient is a small business owner. He had his operation on a Thursday and was discharged from the hospital two days later. By the following Monday, he was back to work.

“While this is not typical, this just shows the patient’s motivation,” says Dr. Medich. “He understood that failure to act would eventually result in him being diagnosed with colon cancer and recognized that he had a medical issue that was in his power to improve.”

The UPMC Division of Colon and Rectal Surgery offers surgical consultations for patients via telemedicine for conditions such as colon cancer, colon polyps, Crohn’s disease, diverticulitis, inflammatory bowel disease, and ulcerative colitis. To learn more or refer a patient, call 412-647-1705.