Video Related to this Article
- https://www.videogie.org/cms/asset/4d75d9cc-61db-470d-80bf-12bb21913c52/mmc1.mp4Loading ...
- •Endoscope: CF-H260 DL; Olympus KeyMed, Southend-on-Sea, UK.
- •Injection solution: 19 ml Gelofusine, 1 ml 1:10 000 epinephrine, a few drops of methylene blue.
- •10-mm Snare, Snaremaster, Olympus.
Background and Endoscopic Procedures
Key Learning Points/Tips and Tricks
- •Define the edge of the lesion with dye spray beforehand or with dye in the lift solution.
- •Inject centrally and angle away during lifting to produce maximum vertical lift.
- •Press down firmly and apply suction with a stiff snare to maximize tissue grip.
- •Review the lesion defect carefully for residual polyp.
|Time (min:sec)||Voiceover text|
|00.03 – Start||A 12 mm flat serrated lesion is seen highlighted by chromoendoscopy. Careful inspection shows no areas of suspected adenomatous change or depressed elements.|
|00.20 – Injection||Injection to lift the lesion is performed. Note that the injection is placed centrally in the lesion. As injection continues the needle is lifted away from the lesion to achieve a high lift directly under the lesion with minimal lateral dispersal.|
|00:38 – Post-lift||The lesion is well lifted on a hemispherical dome of gelofusin. This “half golf ball” shape helps the snare engage the sides of very flat lesions.|
|00:53 – Snaring||A small stiff snare is placed over the lesion and downward pressure and suction is applied to protrude the lesion though the snare and help with grip. The bulge through the snare means that all polyp tissue is captured.|
|01:13 – Movement||The polyp is moved back and forth to ensure that it moves freely on the wall and that underlying muscle has not been snared.|
|01.21 – Open-close||The snare is slightly opened and closed to allow muscle that might have been snared to drop back.|
|01.28 – Cutting||The polyp is then resected, with rapid snare closure and “Endocut”. This ensures minimal diathermy injury to the thin wall of the right colon.|
|01:38 – Inspection defect||The defect is now carefully inspected looking for over deep resection the so called “target sign”, bleeding from vessels, or residual polyp tissue at the lesion edge. In this case the lesion has been resected en bloc and there is no residual tissue. Should fragments be seen they can be further snare resected or ablated with argon plasma coagulation.|
- Sporadic and Syndromic Hyperplastic Polyps and Serrated Adenomas of the Colon: Classification, Molecular Genetics, Natural History, and Clinical Management.Gastroenterol. Clin. North Am. 2008; 37: 25-46
- Role of the Serrated Pathway in Colorectal Cancer Pathogenesis.Gastroenterology. 2010; 138: 2088-2100
- Increased Polyp Detection Using Narrow Band Imaging Compared with High Resolution Endoscopy in Patients with Hyperplastic Polyposis Syndrome.Endoscopy. 2011; 43: 676-682
- Arandomized, Double-Blind Trial of Succinylated Gelatin Submucosal Injection for Endoscopic Resection of Large Sessile Polyps of the Colon.Am. J. Gastroenterol. 2010; 105: 2375-2382
- Hyperplastic-Like Colon Polyps that Preceded Microsatellite-Unstable Adenocarcinomas.Am. J. Clin. Pathol. 2003; 119: 778-796
- Endoscopic Mucosal Resection Outcomes and Prediction of Submucosal Cancer from Advanced Colonic Mucosal Neoplasia.Gastroenterology. 2011; 740: 1909-1918
This article is part of an expert video encyclopedia. Click here for the full Table of Contents.
User licenseCreative Commons Attribution – NonCommercial – NoDerivs (CC BY-NC-ND 4.0) |
For non-commercial purposes:
- Read, print & download
- Redistribute or republish the final article
- Text & data mine
- Translate the article (private use only, not for distribution)
- Reuse portions or extracts from the article in other works
- Sell or re-use for commercial purposes
- Distribute translations or adaptations of the article
Elsevier's open access license policy