By Toyooki Sonoda
This ebook presents surgeons and gastroenterologists with cutting-edge options by way of complicated colonoscopy. Chapters introduce tools of removal polyps that weren't formerly amenable to colonoscopic snare polypectomy. complex thoughts comparable to closure of perforations and intestinal stenting are greatly coated. The textual content keeps a powerful emphasis on surgical/endoscopic strategy. large dialogue on gear and talent acquisition can be coated. As many readers won't ever have obvious those advanced methods sooner than, broad photos and movies are supplied. The authors supply suggestions, methods, and pitfalls that may support the reader include those new strategies into their practice.
Advanced Colonoscopy: Polypectomy and past should be of significant price to any physician or gastroenterologist at the moment appearing colonoscopy and drawn to complicated techniques.
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Extra info for Advanced Colonoscopy: Principles and Techniques Beyond Simple Polypectomy
Suction will further pull the polyp up into the snare loop, and a few wiggles can consolidate this even further. The snare is then tightened gradually until it is tight around the polyp. M. Church Fig. 3 (a) Medium-sized sessile polyp in the ascending colon. (b) Snare placed around the polyp. (c) Polypectomy complete snare and that no more than 2 cm of polyp is trapped. Using pure coagulation current applied in short bursts, the snare is closed. Sometimes it takes a few seconds and several bursts of current for the polyp to be transected.
It is possible to cut and dissect the submucosal layer in as much detail as desired using these devices, and they can be manipulated in every direction for resection. However, this dissection is time-consuming, and it is easy to make mistakes that can cause perforation. The needle knife is the oldest and simplest knife that sharply cuts the tissue at the tip of the knife. However, when applied in a perpendicular direction to the intestinal wall, the knife can easily penetrate the entire bowel wall resulting in perforation.
If the lesion locates itself on the opposite side, it is necessary to move the lesion to the ideal position by rotating the scope, by shortening the loop, and by changing the body position. Submucosal Injection Good submucosal elevation is a key to successful EMR. Ideal submucosal injection is one that makes snaring easy, better visualizes the lateral margins (especially the oral margin), and makes an adequate space between the lesion and muscle layer. For large lesions, the injection should be started from the oral side of the lesion (farthest from the scope) which is the more difficult area to visualize, and subsequent injections can be applied to the anal side of the lesion as necessary.