Cecum - Flat Lesion - EMR
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Case description
This video shows a case of elderly patient who is a head and neck cancer survivor.
Problem: Resection of a sigmoid colon pedunculated polyp revealed adenocarcinoma that was less than 1000 micrometer from the resection edge; this will require surgery as the risk of lymph node invasion is high in such cases. In addition a large cecal polyp was observed that was removed with piecemeal EMR.
Polyp: Laterally spreading granular tumor; size 4-5 cm.
Injection: IndigoCarmine solution without epinephrine; injected in the center as I felt that it may not lift easily if injected in the periphery first. Total 16 ml injected.
Snare resection: 15 and 10 mm snares were used; combination of a little bit of coagulation current followed by endocut current. Blue base indicated plane of resection limited to submucosa; central scarred area. APC of the edge and central scar area.
Clip closure: 8 clips were used to close the defect.
Pathology: Villous adenoma with multifocal high grade dysplasia (intramucosal cancer).
Problem: Resection of a sigmoid colon pedunculated polyp revealed adenocarcinoma that was less than 1000 micrometer from the resection edge; this will require surgery as the risk of lymph node invasion is high in such cases. In addition a large cecal polyp was observed that was removed with piecemeal EMR.
Polyp: Laterally spreading granular tumor; size 4-5 cm.
Injection: IndigoCarmine solution without epinephrine; injected in the center as I felt that it may not lift easily if injected in the periphery first. Total 16 ml injected.
Snare resection: 15 and 10 mm snares were used; combination of a little bit of coagulation current followed by endocut current. Blue base indicated plane of resection limited to submucosa; central scarred area. APC of the edge and central scar area.
Clip closure: 8 clips were used to close the defect.
Pathology: Villous adenoma with multifocal high grade dysplasia (intramucosal cancer).
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