This 37 year old lady had 2 large lesions found for evaluation of un-related abdominal pain
One was on a large stalk (pedunculated), the other one was flat and had a mucous cap as the “give away” clue.
They were completely resected using different techniques.
Snare polypectomy – large pedunculated polyps can typically be removed by transecting the stalk of the polyp with electrocautery. The first lesion was removed using this technique.
Endoscopic mucosal resection (EMR) – this technique is more suitable for large sessile polyps, such as the flat lesion in this case. Whilst smaller lesions can be removed en-bloc, larger lesions are usually removed piecemeal.
Endoscopic submucosal dissection (ESD) – is a variant of EMR in which a specialised needle knife is used to dissect lesions away from the submucosa, in one piece. This technique is typically not required for colon polyps because the majority of colon polyps are benign, so they can be removed piecemeal with a low recurrence risk.
The patient went home the same day.
Like all patients who have undergone endoscopic resection of large adenomas, this patient requires close surveillance to remove any subsequent lesions that might arise.
The follow-up protocol will depend on the manner of resection and histology.
