Large adenoma located in the rectum. LST inhomogeneous Granular type – Paris IIa+Is.
At the index colonoscopy, a hot snare “biopsy” was performed at the lower edge of the adenoma. Histology showed tubulo-villous (mixed type) adenoma with low-grade dysplasia.
Patient was referred for EMR.
There was an adenoma towards the proximal end of the stalk, preventing the use of a ligation band. Lifting agent was saline, spot and adrenalin. Clips to prevent bleeding. Histology showed tubular adenoma with high grade neoplasia.
Instrument used: combined snare and needle. Needle 5 mm long, snare width 25 mm.
When using a ligation device, it is recommended to place the pendunculated polyp at 12 o’clock. To benefit from the gravity, thus clearly define the stalk.
This Video describes perfectly, why we perform ESD of Colon Neoplasia.
The 25 mm Snare leaves a small remnant of adenoma.
Thus becoming a piece-meal resection.
Circumferential incision of mucosa with snare. Snare polypectomi. Lifting agent: spot, adrenalin and saline.
Histopathology tubular adenoma, low grade neoplasia.
The patient had not paused the profylactic treatment of Rivaroxaban.
Histology tubular adenoma, low grade neoplasia.
Normal anastomosis after right-sided hemi-colectomi.
Notice the peristalsis of the ileum.
Incomplete stenosis, dilated by endoscope.
Notice retention of clips from stapler.
5 years after right sided hemicolectomi.
Notice the moderately aggregation of lymphoid tissue in terminal ileum (normal variance).
