By Toyooki Sonoda
This ebook offers surgeons and gastroenterologists with state of the art thoughts by way of complicated colonoscopy. Chapters introduce equipment of removal polyps that weren't formerly amenable to colonoscopic snare polypectomy. complicated recommendations corresponding to closure of perforations and intestinal stenting are widely coated. The textual content continues a robust emphasis on surgical/endoscopic method. wide dialogue on gear and ability acquisition is usually lined. As many readers won't ever have noticeable those complicated methods prior to, vast photos and videos are supplied. The authors supply advice, tips, and pitfalls that would aid the reader comprise those new ideas into their practice.
Advanced Colonoscopy: Polypectomy and past can be of significant worth to any medical professional or gastroenterologist at present acting colonoscopy and attracted to complicated techniques.
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Extra info for Advanced Colonoscopy: Principles and Techniques Beyond Simple Polypectomy
The best way to use it is to place the ceramic ball in the submucosal layer to hook the mucosa or the submucosal connective tissue and then pull back on the knife. This is the only way to cut smoothly using an IT knife, so the knife sometimes has to be applied blindly, which risks complications such as bleeding and perforation. Recently, a scissors-type device such as the ClutchCutter (Fujifilm Corporation) has been developed, which can grasp, cut, or coagulate the targeted tissue using electrosurgical current, and is currently in investigation to see if it ameliorates some of the risks of ESD.
Sometimes it takes a few seconds and several bursts of current for the polyp to be transected. Patience and a stout heart may be required. When the polyp starts to shake, this is a sign that transection is imminent (Fig. 3a–c). If the snare keeps sliding off the polyp, the polyp may be injected with submucosal saline in one corner, which may raise the lesion enough for the snare to stick. Alternatively, a corner of the polyp can be coagulated with hot biopsy forceps. The coagulation and the associated edema raise the lesion so that the snare will grip.
2013;28(8):1127–34. 4. Sagawa T, Kakizaki S, Iizuka H, Onozato Y, Sohara N, Okamura S, Mori M. Analysis of colonoscopic perforations at a local clinic and a tertiary hospital. World J Gastroenterol. 2012;18(35):4898–904. 5. Luigiano C, Consolo P, Scaffidi MG, Strangio G, Giacobbe G, Alibrandi A, Pallio S, Tortora A, Melita G, Familiari L. Endoscopic mucosal resection for large and giant sessile and flat colorectal polyps: a single-center experience with long-term follow-up. Endoscopy. 2009;41(10):829–35.