直肠EMR

                               
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73 y.o. woman found to have a large TVA approximately 5cm above anal verge on colonoscopy. Lesion was partially resected by snare cautery resection prior to referral to me for EMR which resulted in some scarring at the distal margin. Lower EUS was initially performed showing mucosal invovement, followed by completion resection by saline-assisted EMR using a 33mm Captivator II snare (BSCI 2:05) for the majority of the procedure, and use of a Traction Snare (Ovesco 3:43) to resect the flat scarred down region of the polyp which was previously cauterized. Procedure was performed using an Olympus upper endoscope, but in hindsight may have been easier with a flex sig or colonoscope as the instrument channel exits more towards 5-o'clock versus 7-o'clock shown here.