Colonoscopy: Subtle Flat Lesions
Case description
Multiple learning points:
1. Short straight scope: Helps you to rotate the scope in the ascending colon easily and bring the lesion to 6 or 9 ' O clock as shown here.
2. Take time to examine: Look for subtle color and texture changes; subtle flat lesions are easy to miss.
3. Spasms: Hold on to the lesion or close to lesion, especially if it was a small lesion, and let the spasm resolve before removing the lesion. Water immersion helps in some of these cases.
4. Document complete resection for all lesions, big and small: If you do not check you may leave tumor behind especially when removing small polyps with a forceps.
5. Keep in mind whether you had a tough time to negotiate the sigmoid colon; if so I try to take preventive measures after resection.
1. Short straight scope: Helps you to rotate the scope in the ascending colon easily and bring the lesion to 6 or 9 ' O clock as shown here.
2. Take time to examine: Look for subtle color and texture changes; subtle flat lesions are easy to miss.
3. Spasms: Hold on to the lesion or close to lesion, especially if it was a small lesion, and let the spasm resolve before removing the lesion. Water immersion helps in some of these cases.
4. Document complete resection for all lesions, big and small: If you do not check you may leave tumor behind especially when removing small polyps with a forceps.
5. Keep in mind whether you had a tough time to negotiate the sigmoid colon; if so I try to take preventive measures after resection.
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