Can a D&C Miss or Leave Behind an Endometrial Polyp?

Yes, a blind Dilation and Curettage (D&C) can miss or leave behind an endometrial polyp. Because a traditional D&C is performed without a camera, the surgeon cannot see inside the uterus to directly target the polyp ^[1][2]. Instead, the procedure relies on sampling without direct visualization, which means a polyp—especially a small one or one in an unusual location—can easily be missed or only partially removed.

Blind Procedures vs. Camera-Guided Removal

The endometrium is the lining of the uterus, and an endometrial polyp is a “focal” lesion, meaning it grows in a specific, localized spot.

During a blind D&C, the cervix is gently opened (dilation) and a small instrument is used to scrape the general lining of the uterus (curettage). Because this is a blind procedure without direct visualization, the doctor cannot see the polyp. Research shows that a D&C alone has low diagnostic accuracy for finding polyps. In one study, blind curettage correctly identified focal pathology in only 56% of cases, whereas camera-guided procedures were over 90% accurate ^[3].

In contrast, hysteroscopic polypectomy uses a hysteroscope—a thin, lighted tube with a camera—to look directly inside the uterus. This allows the surgeon to visually locate the polyp, identify exactly where it attaches to the uterine wall, and precisely remove it ^[1][4]. Because of this, medical guidelines generally recommend hysteroscopy for diagnosing and treating focal lesions like polyps, while advising against relying on a blind D&C ^[1].

Why Complete Removal Matters

Not every small, asymptomatic polyp requires immediate surgery; depending on your age, symptoms, and risk factors, your doctor might recommend observation. However, if a polyp needs to be removed, complete removal is important for several reasons:

• Accurate Testing (Pathology): All removed polyp tissue must be sent to a pathology lab (a specialized laboratory examination) to check for abnormal cells ^[1]. While most polyps are benign, a small percentage can contain precancerous cells or cancer, with the risk being higher in women who are postmenopausal or experiencing abnormal bleeding ^[5]. If a blind procedure misses the polyp or leaves residual tissue behind, that tissue cannot be tested, which could delay a serious diagnosis.
• Symptom Relief: If the polyp is causing abnormal bleeding, leaving tissue behind means the bleeding may persist or recur. (Keep in mind that bleeding can also have other causes).
• Regrowth: Polyps can recur, and leaving residual tissue increases the chance that a new growth will form.

Can a Hysteroscopy Miss Polyps?

While camera-guided hysteroscopy is the preferred approach, no procedure is absolutely perfect. In rare cases, hysteroscopic removal can also be incomplete. A large study of over 1,400 patients found that residual tissue was left behind in a small fraction of cases (39 patients) ^[6]. This was more likely to happen if the polyp was located in a difficult-to-reach area, such as the “tubal corners” where the fallopian tubes meet the uterus ^[6].

Why Might a D&C Still Be Part of the Plan?

While a blind D&C is not the right tool for removing a specific polyp, you might still see it mentioned in your care plan or hear that it is an alternative. Sometimes, a doctor will perform a hysteroscopy to target the polyp, but also perform a D&C or other endometrial sampling to check the general uterine lining. This additional sampling is not always necessary and carries its own risks (such as bleeding, infection, or uterine perforation), but it may be considered if you have heavy bleeding, are older, or have risk factors that require checking the rest of the uterus for diffuse disease.

Next Steps and Warning Signs

If you have already had a blind D&C or endometrial sampling and the pathology results were benign, but you continue to experience abnormal bleeding or imaging still shows a suspected polyp, it is important to follow up. Guidelines recommend further evaluation (such as a hysteroscopy) when a focal lesion is suspected but blind sampling does not find it ^[7].

When to Seek Immediate Care: If you have recently had a uterine procedure (D&C or hysteroscopy), contact your care team urgently or go to the emergency room if you experience heavy bleeding (soaking more than a pad an hour), fever, worsening severe pain, foul-smelling discharge, or feeling faint.