Meg

g 18.3 cont.

For polypectomy of sessile polyps, the snare should be positioned around the polyp head so that the snare wire closes exactly around the base, if possible without including normal bowel mucosa.

The snare is then closed and the polyp lightly lifted in order to avoid contact during diathermy with the neighboring or surrounding bowel wall.

'iL o u o ■a c the wall and when resecting voluminous polyps, it can be sufficient to induce necrosis in the bowel wall, ultimately causing perforation. When the snare is closed around the polyp, the thickness of the submucosa and muscle layer is only about 1 mm. Thus, when ensnaring sessile polyps, the snare must be positioned so that the snare wire can close around the base of the polyp without including any normal bowel mucosa (0 18.3e). The snare is then closed and the ensnared polyp is lifted slightly to avoid contact with the surrounding or opposite bowel wall during diathermy (0 18.3f).

Broad-based polyps. 0 18.4 shows two approaches for polypectomy of broad-based, sessile polyps. Larger polyps are removed in pieces or portions ("piecemeal" resection technique), if necessary, in several sessions over a period of a few weeks. If a sessile polyp is on a haustra, the distal part of the polyp should be resected first. This can cause tissue retraction during healing of the coagulation ulcer that leads to better positioning of the proximal part of the polyp. Retroflexion of the instrument can be helpful for viewing portions of the polyp located behind a haustrum. It can also assist investigation and removal of polyps

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