By Toyooki Sonoda
This e-book presents surgeons and gastroenterologists with cutting-edge ideas when it comes to complicated colonoscopy. Chapters introduce equipment of elimination polyps that weren't formerly amenable to colonoscopic snare polypectomy. complex recommendations reminiscent of closure of perforations and intestinal stenting are widely coated. The textual content continues a robust emphasis on surgical/endoscopic method. vast dialogue on gear and ability acquisition can also be coated. As many readers won't ever have noticeable those complicated techniques earlier than, wide images and videos are supplied. The authors supply tips, tips, and pitfalls that may support the reader contain those new options into their practice.
Advanced Colonoscopy: Polypectomy and past should be of serious price to any health practitioner or gastroenterologist presently appearing colonoscopy and attracted to complicated techniques.
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Extra info for Advanced Colonoscopy: Principles and Techniques Beyond Simple Polypectomy
Correlations between lymph node metastasis and depth of submucosal invasion in submucosal invasive colorectal carcinoma: a Japanese collaborative study. J Gastroenterol. 2004;39(6):534–43. 2. Ueno H, Mochizuki H, Hashiguchi Y, Shimazaki H, Aida S, Hase K, et al. Risk factors for an adverse outcome in early invasive colorectal carcinoma. Gastroenterology. 2004;127(2): 385–94. 3. Saitoh Y, Obara T, Watari J, Nomura M, Taruishi M, Orii Y, et al. Invasion depth diagnosis of depressed type early colorectal cancers by combined use of videoendoscopy and chromoendoscopy.
Endoscope It is preferable for the endoscopes to be equipped with a water-jet system to wash away blood or mucus from the area of interest. ESD is principally carried out by using a single-channel upper gastrointestinal endoscope with a water-jet system (GIF-Q260J; Olympus Medical Systems Co, Tokyo, Japan), because of ease of manipulation of a more narrow scope. In case of tumors located in the proximal colon which are not reachable by the upper endoscope, a slim colonoscope with a water-jet system (PCF-Q260JI; Olympus Medical Systems Co, Tokyo, Japan) is used.
The endoscopy assistant can assess the thickness of the tissue contained within the snare and make sure it matches the thickness of the stalk seen on the screen. The stalk can be clipped either before or after transection or injected with adrenaline either before or after (Fig. 2). 2 Difficult Polyps: Conventional Methods 23 Fig. 2 Injection of the stalk of a pedunculated adenoma before snaring Sessile/Flat Polyps Snaring large sessile polyps poses a different set of challenges. While the polyps rarely obliterate the lumen and are easier to see, they may overlap haustral folds and may be of a low enough profile to make snaring difficult.