Colonoscopy: Rectal Tumor - LST-Granular Tumor - Piecemeal EMR

08.06.2014
Patient: Middle aged woman underwent screening colonoscopy; found to have a large flat lesion in the rectum - a laterally spreading granular tumor. Preparation: Split dose PEG-Electrolyte solution Sedation: Conscious sedation Endoscope: Cap-fitted pediatric colonoscope with CO2 Patient position: Left lateral position allowed the lesion to be non-dependent; ideal for cutting - allows resected specimens to fall away from the operating site and bleeding can be seen easily. Injection: Saline mixed with Indigo Carmine solution (without Epinephrine); total injected 60 cc. Snare: Stiff snare 10 mm size Cautery: Endocut Q 3-1-3 Hemostatic forceps with soft coagulation at 60 W for bleeding control Hot biopsy with Endocut Q 3-1-3 for residual polyp removal - using avulsion technique at the end of the procedure APC of the edge with 30 Watts Specimen removal: Net Postprocedure: Observed for 1 hour; reexamined at 5 hours; email communication daily. Diet: Liquid diet for 2 days; low residue diet for 2 days; regular diet on day 5. Minor bleeding 1 episode within first 24 hours. Pathology: Villous adenoma; high grade dysplasia; poorly differentiated adenocarcinoma Plan: Evaluation with MRI using rectal protocol, CT abdomen and chest & Surgical consult.

Похожие видео