Cecal Colon, 20 Millimeters Flat Polyp, Underwater Hybrid Polypectomy

We describe how to treat a cecal, 20 millimeters flat polyp, discovered during a screening colonoscopy. As you will see we didn’t use a distal cap as we decided to reset in the same session.

We can clearly see the lesion, It is about 20 millimeters.

After washing and inspection it is classified as Nice 2,  conecct 2A.

The next step is to decide which technique to use for the resection, the lesion being in a declivated position, we will opt for an underwater resection.

The first step is to flood the lesion with saline water, as we fill the cecum, we try to suck in the air that is next to it,

Then we take a 20 millimeters snare, that we deploy very gently all around the polyp, trying to keep as much apprehension as possible around the polyp,  we mobilize the snare a little to try not to catch muscles, Then we apply an endocut Q2 current, the resection is done, we inspect the edges,  there is still a small residue. the resection will be widened with a cold snare. The advantage of a cold snare is that it is less traumatic and the enlargement of the resection can be easily controlled.

Once the resection is done we will wash and inspect the edges, and especially the defect, is there a vessel to coagulate or not, in this case nothing to coagulate.

Last step is to close the defect with clips,  to avoid delayed perforations as well as bleeding.

For this lesion,  two 16 millimeters clips are enough to close the defect.

Tips for Success.

Avoid overdistension: Keep water volume just enough to expose lesion.. Snare Strategy: Cold + Hot Hybrid.

Hot snare central resection:Apply controlled coagulation current to ensure complete resection and hemostasis.Use a 15–20 mm snare depending on lesion spread and mucosal tension.Cold snare margin trimming:Use a cold snare to resect the outer edges of the lesion.This minimizes thermal injury and improves margin clarity.Closure timing: Clip immediately post-resection before mucosa retracts.