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Dr Ajay M Verma, Dr Solange Serna

©2019 myEndoscopy.co.uk

Kettering General Hospital NHS Foundatio
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Flexi Sig/Colonoscopy Therapies

Cold Snare Polypectomy

For small polyps, often in the right side of the colon, these can be removed by “cold snare” a removal without diathermy to cauterise, the bleeding that occurs is minor and stops in a few minutes.

Mid-sized Rectal Polypectomy

This mid-size polyp in the rectum is being removed. Initially the polyp is approach in retroflexion – the endoscope looking back on itself, this allows a view of the polyp from behind. The polyp is lifted away from the bowel wall by injecting EMR solution around its base (0:00 – 0:37), with a thickened liquid (gelofusine), a blue dye (indigo carmine), and adrenaline. This gelofusine gives a cushion so that the bowel wall is less likely to be damaged as the polyp is removed. The blue dye tinges the normal bowel lining blue (the abnormal polyp tissue stays red) making it clear what tissue needs to be removed (the dye fades over time). the adrenaline causes narrowing of blood vessels to reduce the risk of bleeding. Once the polyp is lifted, a snare (a metal loop) is placed around the polyp base, whilst applying electric current (diathermy) the polyp is cut away, simultaneously the base is being cauterised (0:38 – 0:57). The polyp has been removed from the bowel wall (0:58 – 1:01), any residual polyp tissue is tidied up (1:02 – 1:22). A metal clip is applied to the base to reduce the risks of bleeding further (1:23 – 1:29), the tiny clip falls off by itself in a few days. Finally, the polyp is retrieved using a net (1:30 – 1:37).

Simple Small Polypectomy

This small polyp on a stalk is removed by a snare (a metal loop) placed around the polyp stalk, whilst applying electric current (diathermy) the polyp is cut away, simultaneously the base is being cauterised