925
NOVEL APPROACH TO RESECT COMPLEX PEDUNCULATED POLYP
Date
May 20, 2024
BACKGROUND
Managing giant pedunculated gastrointestinal polyps (>5cm) is challenging due to hemorrhage from a retracted feeding artery and the inability to debulk if the polyp is cut in toto. A detachable snare (endo-loop) is a valuable tool to cinch pedunculated polyp. Its opening size and complex maneuvering limit it, and it usually gets caught in the soft polyp tissue. We describe a novel approach to resect the difficult pedunculated polyps.
CASE PRESENTATION
A 60-year-old Female was noted to have an incidental 6 cm polyp with a 3 cm stalk during MRI. Biopsy revealed an adenoma with low-grade dysplasia. As the patient was hoping to avoid surgical resection, we proceeded with EGD to evaluate the possible resection. Various attempts were unsuccessful to cinch this pedunculated polyp, including a standard detachable snare, dual scope to manipulate the detachable snare, and endoscopic purse-string suturing (IMAGE 1).
PREPARATION OF NOVEL SNARE AND ENDOSCOPIC INTERVENTION
A novel large-diameter detachable snare with a knot was created. A double-channel scope was preloaded with the novel detachable snare, and the knot was held with pin-less biopsy forceps to help steer the detachable snare (Image 2). With this approach, we successfully cinched the peduncle of the polyp. The polyp was debunked till we reached the peduncle. Given the smaller size, we could then place the standard detachable snare and successfully retrieved the peduncle separately so that the involvement of the peduncle could be assessed.
CONCLUSION:
We demonstrate the successful use of customized large-diameter detachable snare steered with pin-less forceps to safely and successfully remove a giant pedunculated gastric polyp
Managing giant pedunculated gastrointestinal polyps (>5cm) is challenging due to hemorrhage from a retracted feeding artery and the inability to debulk if the polyp is cut in toto. A detachable snare (endo-loop) is a valuable tool to cinch pedunculated polyp. Its opening size and complex maneuvering limit it, and it usually gets caught in the soft polyp tissue. We describe a novel approach to resect the difficult pedunculated polyps.
CASE PRESENTATION
A 60-year-old Female was noted to have an incidental 6 cm polyp with a 3 cm stalk during MRI. Biopsy revealed an adenoma with low-grade dysplasia. As the patient was hoping to avoid surgical resection, we proceeded with EGD to evaluate the possible resection. Various attempts were unsuccessful to cinch this pedunculated polyp, including a standard detachable snare, dual scope to manipulate the detachable snare, and endoscopic purse-string suturing (IMAGE 1).
PREPARATION OF NOVEL SNARE AND ENDOSCOPIC INTERVENTION
A novel large-diameter detachable snare with a knot was created. A double-channel scope was preloaded with the novel detachable snare, and the knot was held with pin-less biopsy forceps to help steer the detachable snare (Image 2). With this approach, we successfully cinched the peduncle of the polyp. The polyp was debunked till we reached the peduncle. Given the smaller size, we could then place the standard detachable snare and successfully retrieved the peduncle separately so that the involvement of the peduncle could be assessed.
CONCLUSION:
We demonstrate the successful use of customized large-diameter detachable snare steered with pin-less forceps to safely and successfully remove a giant pedunculated gastric polyp
Image 1: Failed standard detachable snare, dual scope manipulation and endoscopic purse string suturing
Image 2: Novel detachable snare assembly and pin-less forceps to steer were preloaded in a double-channel scope
Speakers
Presenter
Tracks
Related Products
PREDICTORS OF ADVERSE EVENTS FOLLOWING X-TACK USE: A CASE CONTROL ANALYSIS OF A POST-MARKETING REGISTRY
Introduction: The X-Tack system is a device used for soft-tissue approximation in minimally invasive endoscopic procedures, and for stent or enteral tube fixation. Since it is a relatively new device, sparse data exists on potential adverse events that may occur following its use…
BAND ASSISTED DRAIN
Visceral artery pseudoaneurysms include aneurysms of the celiac, superior, or inferior mesenteric arteries and their branches. Pseudoaneurysms have a high risk of rupture with life threatening consequences…
TOWING THE STENT TO MANAGE MALIGNANT GASTRO-ENTERO-COLONIC FISTULA AND COLONIC OBSTRUCTION
Gastro-entero-colonic fistulas resulting from either stomach or colonic malignancies are highly morbid and challenging to manage…
NOVEL DEPLOYMENT OF SPIRATION VALVES - A CASE SERIES
Malignant colorectal polyps are defined as lesions that invade into the submucosa and represent early colorectal cancer (T1 by the TNM Classification of Malignant Tumors system)…
