By Toyooki Sonoda
This publication offers surgeons and gastroenterologists with state of the art suggestions by way of complex colonoscopy. Chapters introduce tools of removal polyps that weren't formerly amenable to colonoscopic snare polypectomy. complex ideas comparable to closure of perforations and intestinal stenting are widely coated. The textual content keeps a robust emphasis on surgical/endoscopic approach. large dialogue on gear and ability acquisition is usually coated. As many readers won't ever have visible those complicated methods prior to, large images and movies are supplied. The authors offer counsel, methods, and pitfalls that would aid the reader contain those new ideas into their practice.
Advanced Colonoscopy: Polypectomy and past should be of significant price to any health care professional or gastroenterologist at the moment appearing colonoscopy and attracted to complicated techniques.
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Extra resources for Advanced Colonoscopy: Principles and Techniques Beyond Simple Polypectomy
After removal, they can be aspirated more easily through the suction channel than adenomas, and so the specimens are more readily obtained. 2 Difficult Polyps: Conventional Methods 19 5. Scarring: Polyps that have been interfered with by biopsy or prior attempts at removal become scarred. The scarring can fix them to the mucosa, making subsequent attempts at polypectomy difficult. “Conventional” Techniques Conventional polypectomy techniques are those practiced by the majority of colonoscopists: snare polypectomy and polyp excision by biopsy forceps.
7. Shirai M, Nakamura T, Matsuura A, Ito Y, Kobayashi S. Safer colonoscopic polypectomy with local submucosal injection of hypertonic saline-epinephrine solution. Am J Gastroenterol. 1994;89(3):334–8. 8. Uraoka T, Fujii T, Saito Y, Sumiyoshi T, Emura F, Bhandari P, et al. Effectiveness of glycerol as a submucosal injection for EMR. Gastrointest Endosc. 2005;61(6):736–40. 9. Fujishiro M, Yahagi N, Kashimura K, Mizushima Y, Oka M, Enomoto S, et al. Comparison of various submucosal injection solutions for maintaining mucosal elevation during endoscopic mucosal resection.
The stalk is transected. Ideally this should all be under direct vision, but difficult polyps may be so large as to fill the lumen of the colon (especially in the sigmoid), making the stalk difficult to see. They may be too large for the snare to encompass or they may be too mobile to pin down. Finally the stalk may be wide and scary (Fig. 1a, b). For successful and safe polypectomy, the stalk must first be recognized. The scope is pushed past the polyp, and during this process it is usually possible to see a stalk.