By Toyooki Sonoda
This publication offers surgeons and gastroenterologists with state of the art thoughts by way of complicated colonoscopy. Chapters introduce equipment of elimination polyps that weren't formerly amenable to colonoscopic snare polypectomy. complicated thoughts resembling closure of perforations and intestinal stenting are widely coated. The textual content continues a powerful emphasis on surgical/endoscopic method. vast dialogue on gear and talent acquisition can be lined. As many readers won't ever have obvious those complicated tactics earlier than, large photos and movies are supplied. The authors offer advice, methods, and pitfalls that might support the reader contain those new ideas into their practice.
Advanced Colonoscopy: Polypectomy and past can be of serious worth to any health care provider or gastroenterologist at the moment acting colonoscopy and drawn to complicated techniques.
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Extra resources for Advanced Colonoscopy: Principles and Techniques Beyond Simple Polypectomy
The state of the rest of the colon is also important. A proximal cancer is a contraindication to removal of a distal polyp. If there are multiple polyps, restrict resection to one area of the colon and leave other areas for another day, so that post-polypectomy bleeding can only be coming from one site. In summary, removal of a difficult lesion should only be attempted in a good-risk patient with a clean colon that is free of more advanced lesions. 1 for the prerequisites for safe polypectomy. 1 Prerequisites for safe polypectomy Excellent or good bowel preparation Straight colon Cooperative patient No proximal colon cancer Relatively fit patient with life expectancy >3 years 2 Difficult Polyps: Conventional Methods 21 Controlling the Colonoscope Control of the colonoscope is an important part of safe polypectomy technique.
The nature of the epithelium allows it to be drawn up easily into the snare. Here, injection of adrenalin or saline may be counterproductive, making a slippery dome out of what was wrinkled redundant mucosa. The key is to encompass the whole lesion with the snare and to push down proximally with the snare sheath (Fig. 5a–c). The edges of sessile serrated adenomas/polyps can be indistinct and may be snared separately by switching to a mini snare. Alternatively, they can be coagulated with a hot biopsy forceps.
4a–c). An alternative for polyps draped Fig. 4 (a) Large polyp in the mid-ascending colon over a fold. (b) Scope retroflexed in the ascending colon. M. Church over a fold is to raise them by submucosal saline injection distally. Also, the fold can be flattened by pushing down with the snare sheath or by changing patient position. Begin polypectomy with the part behind the fold. Large Sessile Rectal Polyps The rectum is a unique part of the large intestine because it is normally empty of stool, has very intermittent peristalsis, and has a peculiarly compliant wall with redundant mucosa.
Advanced Colonoscopy: Principles and Techniques Beyond Simple Polypectomy by Toyooki Sonoda