Huge Mass Of The Descending Colon (4 of 25)

In order to perform hemostasis a solution of adrenaline 1 / 10,000 in a 50% dextrose was inyected, note the color change after this hemostatic maneuver. The intent of the injection is to instill saline in the submucosal space directly under the polyp, elevating the mucosa from the muscularis propria layer. A needle is placed into the submucosal space and fluid injected. The colon wall is extremely thin, varying in thickness from 1.7 to 2.2 mm. Approximately one third of the thickness of the colon wall is composed of mucosa, one third submucosa, and one third muscularis propria. Injection of fluid into the submucosal layer increases the distance between the mucosa and the outer muscular layer of the bowel wall. Endoscopic mucosal resection (EMR) in the colon has now come to have the same meaning as "saline-assisted polypectomy" (SAP), or a more recently used term, "submucosal injection polypectomy" (SIP), which more precisely describes the injection technique. Utilizing SIP, it is possible to safely remove both large and small polyps.