KWT Medicals News   •   Feb 23, 2019

Adiminutive sessile polyp has been revealed by dye spray, a pair of biopsy forceps is placed next to the polyp which confirms the polyp is smaller than the biopsy cups and will be excised in single bite.

The forceps are opened note they protrude just beyond the end of the scope to ensure precision they have placed accurately over the polyp and completely engulf it. Although a small hematoma has developed no residual polyp tissue can be seen.

Hot Biopsy

A three millimeter polyp is assessed for removal by hot biopsy, the lesion is grasped and then mucosa is tented away from the bowel wall. Forced coagulation is applied in a short burst leading to whitening at the tip the Mount Fuji effect. As soon as whitening is seen no further current should be applied the biopsy sample is then removed.

Cold Snare

A three-millimeter polyp is seen on the edge of a fold deliberately aligned the five o’clock position with the biopsy Channel. a small stiff snare is selected and adjusted to halfway open just wide enough to capture the polyp. The snare is pressed down on the polyp with suction to capture the polyp and a small rim of normal tissue. The snare is then closed without diathermy to guillotine the polyp.

After resection, the polyp is retrieved with suction via the biopsy channel. the Polly pecked me the site is then carefully inspected to ensure no residual polyp tissue is left.

Hot Snare

The edge of a small sessile polyp is seen over a fold in the ascending colon. Using the catheter from the snare the fold can be depressed to reveal the full extent of the polyp on the back of the fold.

The lesion is a little larger than it first appeared, the snare is opened above and beyond the lesion and dragged back to keep the lesion in view while the snare is positioned. Downward pressure and suction help protrude the tissue through the snare to aid grip.

The tissue is tended away from the bowel wall and then transfected using rapid closing of the snare and Endicott to avoid significant diathermy injury to the bowel wall.

The polyp pre-positioned at five o’clock is then easily suctioned for retrieval. The polypectomy site is washed and checked carefully for the residual polyp. again a snare catheter is used to manipulate the fold to ensure an optimal view ensuring all polyp tissue has been resected.