Abstract
Colonoscopic polypectomy is a major advance in the therapy of colon neoplasms. The techniques for safe and efficient polyp removal are described. The uses of a variety of ancillary devices are discussed, including clips, loops, submucosal injection of fluid, and several thermal probes, including the argon plasma coagulator. The location of a lesion may be difficult to ascertain by intracolonic landmarks, but can be more precisely determined by X-ray, magnetic imaging, or intraoperative colonoscopy. Alternatively, it is possible to permanently mark the site of polyp removal with a carbon particle submucosal injection to facilitate subsequent localization either by surgery or interval colonoscopy.
Highlights
The removal of colonic polyps is a major advance in medicine
Placement prior to polyp removal may result in difficulty with snare placement because of the long "tail." Because immediate post-polypectomy bleeding only occurs in about 1% ofcases [10], an alternate use ofthis device is to place it on the resected stalk to ensure hemostasis postpolypectomy, tissue retraction may flatten the residual pedicle to the extent that the loop cannot be properly seated [11]
Closure of the loop will result in seating the snare on the opposite side of the polyp, since the wire loop always concentrically closes toward the tip ofthe snare sheath, which is the fixed point in the polypectomy system
Summary
Mount Sinai Medical Center," GI Endoscopy Unit, Mount Sinai Hospital, GI Endoscopy Unit, Lenox Hill Hospital (Received 4 October 1999," Revised 7 December 1999," In final form 21 December 1999). Colonoscopic polypectomy is a major advance in the therapy of colon neoplasms. The techniques for safe and efficient polyp removal are described. The uses of a variety of ancillary devices are discussed, including clips, loops, submucosal injection offluid, and several thermal probes, including the argon plasma coagulator. The location of a lesion may be difficult to ascertain by intracolonic landmarks, but can be more precisely determined by X-ray, magnetic imaging, or intraoperative colonoscopy. It is possible to permanently mark the site of polyp removal with a carbon particle submucosal injection to facilitate subsequent localization either by surgery or interval colonoscopy
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