55 year old gentleman referred for removal of a lesion found at colonoscopy for a positive stool test.
Lesions such as these are best managed in a centre with expertise in Endoscopic Mucosal Resection (EMR) and Endoscopic Submucosal Dissection (ESD)
Whilst en-bloc resection is preferred, piecemeal resection is often necessary due to polyp size or location.
In this case, the lesion lifted and resected well except at the biopsy site.
The stuck down section had to be avulsed with forceps.
The margin of the lesion was ablated to reduce the risk of residual polypoid tissue.
Ablation techniques can include Argon plasma coagulation or thermal ablation.
Regardless of the technique used to remove a large polyp, consideration is given to tattooing the site where the large polyp was removed to permit identification of the site during follow-up endoscopy or surgery.
