Cecum - Large Pedunculated Polyp Resection

This video shows a case of a middle aged man with hypertension and a large pedunculated polyp in the cecum. Recommended to undergo right hemicolectomy.

Problem: Large polyps, thick stalks, cecal polyps, age and hypertension are risk factors for bleeding. In addition, perforation is another risk. Recent advances in endoscopy and clips make it possible to attempt endoscopic resection of these lesions in a center with a team trained in EMR.

Sedation: Total intravenous anesthesia

Polyp: Large cecal polyp with a thick stalk - such thick stalks have multiple feeding vessels.
Injection: A single injection was used to deliver epinephrine to create vasospasm, followed by Indigo carmine (total 15 cc). I watch for the blood pressure before I start injecting epinephrine.

Snare resection: A 25 mm snare was used for resection using endocut and coagulation current. After first cut, it resulted in some bleeding. This was not much, so decided to complete the cut of the remaining segment with a 10 mm snare. It resulted a complete cut, without any residue.

Resection base: Mild bleeding and 2-3 vessels were noted; no tumor residue in the base or edge.

Clip closure: Used a large clip (Cook Clip) to close the defect; applied the clip over the bleeding vessel. Then additional clips were used to close the defect. Because of his travel from abroad, decided to apply clips closely to prevent delayed bleeding.

Pathology: Villous adenoma with high grade dysplasia.