大肠无蒂息肉 - EMR和夹关闭

                               
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Patient: Middle aged man was found to have a large transverse colon polyp during screening colonoscopy; referred to undergo surgery.
Endoscope: Cap fitted adult colonoscope with CO2.
Polyp: Large sessile polyp - 5 cm, with a short broad based pedicle.
Position: During insertion, the patient was in left lateral position; during the resection, the patient was turned to right lateral position for better access, resection, and closure.
Sedation: Conscious sedation; patient was awake during the resection to hold the breath when necessary for a safe and swift resection.
Injection: 3cc of epinephrine (1;10,000) followed by 15 cc of dilute Indigo carmine through a single puncture on the back side of the polyp.
Successful lifting of the lesion.
Snare resection: 25 mm snare; current - coagulation alternating with endocut; second piece with a 10 mm snare.
Bleeding control: APC of the vessel in the base; followed by APC of the edges to prevent recurrence.
Clip closure: 7 clips were used to close the defect placed at close quarters (going back on dual antiplatelet therapy).
Tattoo: close to the resection site.
Net retrieval.
Diet: Liquid diet for 2 days; low residue diet for 2 days, regular diet on day 5.
Followup: No complications
Pathology: Adenocarcinoma 1000 um away from the resection margin; no lymphovascular invasion.
Plan: Discuss in a multidisciplinary conference.