Colonoscopy: Descending Colon LST-NG EMR - Path: Adenocarcinoma

Location: Proximal Descending colon; prior biopsies
Lesion: LST-NG ~ 4 cm
Injection: Saline + Methylene Blue + 1:100,000 Epi; 50 ml
Snare: Stiff Snare - 15 mm and 10 mm
EndocutQ 3-1-5
Quality of lift: Satisfactory except for a small area that was tethered
Technique: Cut around the tethered area and then cut the tethered area (notice the tethered area - injection - backsplash - suggestive of dense fibrosis from prior biopsy) or desmoplastic reaction of cancer.
Hot biopsy avulsion: EndocutI: 1-3-3
Clip closure
Tattoo.
Pathology: Moderately differentiated adenocarcinoma (tethered area submitted separately shows tumor budding noted; margin clear); Hot biopsy avulsion (submitted separately - adenocarcinoma; margin involvement could not be defined due to cautery). Tumor budding is one of the prognostic factors that should be taken into consideration for surgery to make sure there is no lymphatic involvement although the resection base, in this case, was clean.