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|T] 18.2 Polypectomy procedure using an Endoloop on a stalked polyp -

|T] 18.2 Polypectomy procedure using an Endoloop on a stalked polyp -

Hemoclipped Polyp Stalk

a-e Polypectomy procedure for use of an Endoloop on a large stalked polyp. The En-doloop (detachable snare) is positioned around the thick stalk, ligating it. The polypectomy snare is placed above the detachable snare at a sufficient distance to the polyp head for safe and complete resection. After polypectomy, the stalk retracts and becomes necrotic. The En-doloop later falls off.

a-e Polypectomy procedure for use of an Endoloop on a large stalked polyp. The En-doloop (detachable snare) is positioned around the thick stalk, ligating it. The polypectomy snare is placed above the detachable snare at a sufficient distance to the polyp head for safe and complete resection. After polypectomy, the stalk retracts and becomes necrotic. The En-doloop later falls off.

3. The polyp stalk can be hemoclipped (Fig. 18.6). One or more hemoclips are applied to the polyp stalk close to the bowel wall so that compression of the stalk is complete. This technique must also leave space for securely positioning the polypectomy snare closer to the head of the polyp. Similar to the Endoloop, the effect is considered sufficient when ligation causes the proximal polyp stalk and the polyp head to visibly blanch or turn livid.

Given the lack of randomized studies, there are ultimately no clear recommendations for determining which polyps should be preventively treated with prophylactic measures to prevent bleeding. The examiner must decide which technique he or she prefers.

Sessile Polyps

Sessile polyps are attached directly to the colon wall by a broad base. Polypectomy procedure is determined by their size and localization. Sessile polyps in the left hemicolon up to 1.5 cm in size can be removed with a diathermy snare in one session. The snare is encircled around the base of the polyp, directly resting on the intestinal mucosa, and the polyp is removed using diathermy current (E 18.3a-d). If the polyp is localized in the right hemicolon, it should not exceed 1 cm in total size for snare resection, unless submucosal injection of saline (with or without diluted epinephrine) is used to reduce the risk of thermal damage to the colon wall (8). The heat produced by diathermy is transmitted through the submucosa to the serosa of a

Fig. 18.6a, b Large stalked polyp. One or more hemoclips are applied to the polyp stalk close to the bowel wall so that the stalk is completely compressed and ligated. The polypectomy snare is positioned proximal to the hemoclips close to the polyp head so that the polyp can be resected at a sufficient distance from the hemoclips.

Fig. 18.6a, b Large stalked polyp. One or more hemoclips are applied to the polyp stalk close to the bowel wall so that the stalk is completely compressed and ligated. The polypectomy snare is positioned proximal to the hemoclips close to the polyp head so that the polyp can be resected at a sufficient distance from the hemoclips.

- 0 18.3 Polypectomy of sessile polyps

- 0 18.3 Polypectomy of sessile polyps

Sessile Polyps Colon

a-d Procedure for polypectomy of a sessile polyp up to 1.5 cm in size. The snare is placed around the base of the polyp, directly on the bowel mucosa, and the polyp is removed using electrocautery current. The resection site is smooth.

b a-d Procedure for polypectomy of a sessile polyp up to 1.5 cm in size. The snare is placed around the base of the polyp, directly on the bowel mucosa, and the polyp is removed using electrocautery current. The resection site is smooth.

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