Polypectomy
Colon polyp

Video Endoscopic Sequence 1 of 12.

Endoresection of Polyp of Irregular aspect in descending colon.

A 62-year-old female, who underwent a colonoscopy due to a recurrent diarrhea, is found to be this mass, the biopsies revealed to be a tubulo-villous adenoma.

 

 

 

 

 

 

 

Colon polyp

Video Endoscopic Sequence 2 of 12.

Another image and video of tubulo-villius adenoma

Colon polyp

Video Endoscopic Sequence 3 of 12.

Two weeks later the Endo Resection is performed

 

 

 

 

Colon polyp

Video Endoscopic Sequence 4 of 12.

Infiltrations with Saline and adrenaline at 1 / 10,000, are applied.

 

Colon polyp

Video Endoscopic Sequence 5 of 12.

The infiltration of the solution is continued

 

Colon polyp

Video Endoscopic Sequence 6 of 12.

Polypectomy in fragments is carry out

 

 

 

Colon polyp

Video Endoscopic Sequence 7 of 12.

It continues with Endo Resection

 

 

Colon polyp

Video Endoscopic Sequence 8 of 12.

More tissues to be resected

 

Colon polyp

Video Endoscopic Sequence 9 of 12.

Ablative therapy is applied with argon plasma to small remaining fragments.

 

 

Colon polyp

Video Endoscopic Sequence 10 of 12.

The final status of endo-resection is shown

 

 

Colon polyp

Video Endoscopic Sequence 11 of 12.

A hemoclip is applied to a small area where the muscularis is observed

 

Colon polyp

Video Endoscopic Sequence 12 of 12.

Final Status of of Endo Resection. The pacient is scheduled for a new follow-up colonoscopy.

 

 

 

This is the case of a 52 year-old, male who in a routine colonoscopy found a large pedunculated polyp

Video Endoscopic Sequence 1 of 9.

Video Colonoscopic view of a Polypectomy

Polypectomy of a stalked polyp

This is the case of a 52 year-old, male who in a routine colonoscopy found a large pedunculated polyp.

For more endoscopic features download the video clip by clicking on the endoscopic image if you would like to see in full screen, wait to be downloaded the video complete then press Alt and Enter.

All endoscopic images shown in this Atlas contains video clips

 

 

.

 

 

 

Colonic polyps are slow-growing overgrowths of the colonic mucosa that carry a small risk (< 1%) of becoming malignant. However, because colonic polyps are highly prevalent in the general population (especially with increasing age), they confer an important predisposition to colon cancer and are therefore removed when detected.

Video Endoscopic Sequence 2 of 9.

Video Colonoscopic view of a Polypectomy

Colonic polyps are slow-growing overgrowths of the colonic mucosa that carry a small risk (< 1%) of becoming malignant. However, because colonic polyps are highly prevalent in the general population (especially with increasing age), they confer an important predisposition to colon cancer and are therefore removed when detected.

 

Achieving a more complete resection; and diminishing the risk of complications such as perforation, bleeding and transmural burn. Thus, it is also reasonable to use IAP for any polyp that is flat, regardless of its size. By raising the polyp from the submucosa a deeper and more complete resection of the neoplastic tissue can be achieved. In addition, by lifting the submucosa from the deeper layers of the gut wall, the depth of injury is decreased by avoiding the burn at the muscularis propria and serosa. However, submucosal injection even with a large amount of fluid may not avoid perforation if overly large pieces of the polyp are ensnared and resected. Multiple substances are commercially available to perform an IAP.

Video Endoscopic Sequence 3 of 9.

Endoscopic polypectomy with Submucosal injection

injection-assisted polypectomy (IAP).

Achieving a more complete resection; and diminishing the risk of complications such as perforation, bleeding and transmural burn. Thus, it is also reasonable to use IAP for any polyp that is flat, regardless of its size. By raising the polyp from the submucosa a deeper and more complete resection of the neoplastic tissue can be achieved. In addition, by lifting the submucosa from the deeper layers of the gut wall, the depth of injury is decreased by avoiding the burn at the muscularis propria and serosa. However, submucosal injection even with a large amount of fluid may not avoid perforation if overly large pieces of the polyp are ensnared and resected. Multiple substances are commercially available to perform an IAP.


An important related tool to consider for polypectomy is injection with either saline or epinephrine (1:10 000) into the polyp base or stalk. The submucosa is the target location for fluid deposit, so the endoscopist should try not to penetrate the colon wall with the needle. Injected fluid can diffuse fast, so sometimes repeat injections are needed. Injection is suggested in the literature for larger polyps specifically. Most studies looking at resection of large or giant polyps include epinephrine injection in their polypectomy protocol. Injection can lift up flatter polyps rendering them more polypoid and more amenable to snare polypectomy and complete resection. The injected fluid may also serve as a safety cushion by increasing the distance between the mucosa and the muscle layer and serosa, thereby at least theoretically decreasing risk of perforation. If a polyp does not lift with an appropriate injection technique it may be caused by an underlying cancer extending to deeper colon layers. Pedunculated polyps with large stalks are more inclined to bleeding. Injecting these large stalks before snare polypectomy may provide prophylactic hemostasis and reduce the risk of a post-polypectomy bleed. Epinephrine is a potent vasoconstrictor, and both saline and epinephrine can exert a tamponade effect on blood vessels. A study by Dobrowolski randomized 100 polyps to either epinephrine injection or no injection and found one post-polypectomy bleed in the injection group compared to 8 bleeds in the no injection group.

 

 

 

Polypectomy of colonic polyps has been shown to reduce the risk of colon cancer development and is considered a fundamental skill for all endoscopists who perform colonoscopy. A variety of polypectomy techniques and devices are available, and their use can vary greatly based on local availability and preferences. In general, cold forceps and cold snare have been the polypectomy methods of choice for smaller polyps, and hot snare has been the method of choice for larger polyps. The use of hot forceps has mostly fallen out of favor. Polypectomy for difficult to remove polyps may require the use of special devices and advanced techniques and has continued to evolve. As a result, the vast majority of polyps today can be removed endoscopically.

Video Endoscopic Sequence 4 of 9.

Endoscopic polypectomy

After several injections in the pedicle with adrenaline solution, the pedicle is becoming with white color due to vasoconstriction, also vasoconstriction in tissues around the colonic mucosa is observed.

Polypectomy of colonic polyps has been shown to reduce the risk of colon cancer development and is considered a fundamental skill for all endoscopists who perform colonoscopy. A variety of polypectomy techniques and devices are available, and their use can vary greatly based on local availability and preferences. In general, cold forceps and cold snare have been the polypectomy methods of choice for smaller polyps, and hot snare has been the method of choice for larger polyps. The use of hot forceps has mostly fallen out of favor. Polypectomy for difficult to remove polyps may require the use of special devices and advanced techniques and has continued to evolve. As a result, the vast majority of polyps today can be removed endoscopically.

 

 

 

Since of electrosurgery as it pertains to polypectomy. Tattooing of a polypectomy site is an important adjunct to polypectomy and can greatly facilitate future surgery or endoscopic surveillance. The two most common post-polypectomy complications are bleeding and perforation. Their incidence can be decreased with the use of meticulous polypectomy techniques and the application of some prophylactic maneuvers. This review will examine the technique of polypectomy and its complications from the perspective of the practicing gastroenterologist.

Video Endoscopic Sequence 5 of 9.

Video Colonoscopic view of a Polypectomy

The snare loop is placed in the pedicle.

Since of electrosurgery as it pertains to polypectomy. Tattooing of a polypectomy site is an important adjunct to polypectomy and can greatly facilitate future surgery or endoscopic surveillance. The two most common post-polypectomy complications are bleeding and perforation. Their incidence can be decreased with the use of meticulous polypectomy techniques and the application of some prophylactic maneuvers. This review will examine the technique of polypectomy and its complications from the perspective of the practicing gastroenterologist.

 

 

Polypectomy is a fundamental skill utilized by all endoscopists who perform colonoscopy. Mastery of polypectomy is difficult and requires both significant experience and study. It is clear that polypectomy is efficacious in reducing the risk of colon cancer development by interrupting the adenoma to carcinoma progression. Endoscopic techniques used in colonoscopic polypectomy continue to evolve, and it is important for all endoscopists to be familiar with these concepts.

Video Endoscopic Sequence 6 of 9.

Video Colonoscopic view of a Polypectomy

The site where the polyp was removed

Polypectomy is a fundamental skill utilized by all endoscopists who perform colonoscopy. Mastery of polypectomy is difficult and requires both significant experience and study. It is clear that polypectomy is efficacious in reducing the risk of colon cancer development by interrupting the adenoma to carcinoma progression. Endoscopic techniques used in colonoscopic polypectomy continue to evolve, and it is important for all endoscopists to be familiar with these concepts.

 

 

Decision making about how to perform polypectomy is often made during colonoscopy when a polyp is detected. A general rule is that all potential adenomas should be removed. The endoscopic appearance of a polyp is often not necessarily a good indicator of its histologic nature. While as many as 70% of diminutive polyps (less than 5 mm) may be adenomas, the risk of any particular polyp containing malignancy increases with the size of the polyp. The method chosen for polypectomy is often related to the appearance and size of the polyp. Polyps are usually described as being pedunculated, sessile or flat. The risk of a polyp 2 cm in size or larger being malignant is greater than 10%. Some polyps blur the lines though, by not falling into these strict categories. Nevertheless, consideration of polyp characteristics is helpful in determining the best approach to polypectomy.

Video Endoscopic Sequence 7 of 9.

Video Colonoscopic view of a Polypectomy

The site where the polyp was removed

Decision making about how to perform polypectomy is often made during colonoscopy when a polyp is detected. A general rule is that all potential adenomas should be removed. The endoscopic appearance of a polyp is often not necessarily a good indicator of its histologic nature. While as many as 70% of diminutive polyps (less than 5 mm) may be adenomas, the risk of any particular polyp containing malignancy increases with the size of the polyp. The method chosen for polypectomy is often related to the appearance and size of the polyp. Polyps are usually described as being pedunculated, sessile or flat. The risk of a polyp 2 cm in size or larger being malignant is greater than 10%. Some polyps blur the lines though, by not falling into these strict categories. Nevertheless, consideration of polyp characteristics is helpful in determining the best approach to polypectomy.

 

The image and video clips is post-polypectomy, then ablative therapy with argon plasma coagulator is performed.

Video Endoscopic Sequence 8 of 9.

Video Colonoscopic view of a Polypectomy

The image and video clips is post-polypectomy, then ablative therapy with argon plasma coagulator is performed.

 

Polyp in the formalin jar is observed, the histopathology study revealed to be an adenoma tubulovillous.

Video Endoscopic Sequence 9 of 9.

Adenoma Tubulovillous

Polyp in the formalin jar is observed, the histopathology study revealed to be an adenoma tubulovillous.

See the video clip.

 

 

Polypectomy of Stalked Polyp.

Video Endoscopic Sequence 1 of 6.

Polypectomy of Stalked Polyp.

Polyps with a large pedicle at the descending colon.

This 58 year old male who undergone a colonoscopy as a medical control, in the same colonoscopy the polyp was snared .

The histopathologic study displayed tubulovillous adenoma with dysplasia.

Colon Polyp

Video Endoscopic Sequence 2 of 6.

The form of the pedicle is observed.

Polyps on a pedicle usually are removed readily with the snare and cautery technique.

Some polyps are on an extremely long pedicle and can pose a problem for their removal because they tend to swing back and forth during the endoscopic examination.

Colon Polyp

Video Endoscopic Sequence 3 of 6.

With the polypectomy snare, the polyp is fragmented.

Colon Polyp

Video Endoscopic Sequence 4 of 6.

We continued with the technique of polypectomy in fragments.

Colon Polyp

Video Endoscopic Sequence 5 of 6.

More fragments.

Colon Polyp

Video Endoscopic Sequence 6 of 6.

The final status of the endoscopic polypectomy is displayed

polypectomy

Video Endoscopic Sequence 1 of 4.

Video Colonoscopic view of a polypectomy of a big 6 cm. x 4 cm. sessile lesion.

The pictures showed below are the sequence of the removal.

 

Endoscopic polypectomy

Video Endoscopic Sequence 2 of 4.

Note the traction is being performed when the enormous lesion is being removed.

 

Endoscopic polypectomy

Video Endoscopic Sequence 3 of 4.

Status Post Videoendoscopic polypectomy of a huge sessile adenoma. The video clip displays the bleeding and cauterization.

 

Endoscopic polypectomy

Video Endoscopic Sequence 4 of 4.

Status Post Polypectomy.

8 days after the endoscopic procedure, The ulcer is already healing.

Endoscopic polypectomy

Video Endoscopic Sequence 1 of 2.

Enormous Sessile Adenoma of the Rectum.

The primary clinical importance of colorectal adenomas is their well-recognized relationship to colorectal cancer. An abundance of scientific data indicate that almost all colorectal cancers arise from previous benign adenomas.

Compelling evidence for this polyp-cancer sequence includes their similar prevalence in different world populations, their common etiology, and their similar site distribution in the colon.

Endoscopic polypectomy

Video Endoscopic Sequence 2 of 2.

This tumor was removed completely with the snare polypectomy. The procedure was carried out in three different days with piecemeal excision.

 

 

 

Endoscopic polypectomy

Polypectomy of a stalked polyp.

Endoscopic polypectomy

Video Endoscopic Sequence 1 of 2.

Endoscopic polypectomy.

An attempt should be made to bring all polyps into the six o'clock position to facilitate snare placement, and this can usually be accomplished by rotation of the colonoscope relative to the polyp.

Endoscopic polypectomy

Video Endoscopic Sequence 2 of 2.

The polyp has been fallen out.

Endoscopic polypectomy

Video Endoscopic Sequence 1 of 5.

Endoscopic snare excision of large pediculated polyp.
This sequence displays a polypectomy of long stalked Polyps at the transverse colon near splecnic flexure.

Endoscopic polypectomy

Video Endoscopic Sequence 2 of 5.

Placement of a snare wire over the stalk of the polyp.

Endoscopic polypectomy

Video Endoscopic Sequence 3 of 5.

Cautery is applied to the wire loop, which was tightened around the stalk of the polyp.

Endoscopic polypectomy

Video Endoscopic Sequence 4 of 5.

The video clip displays the cutting of the polyp.

Endoscopic polypectomy

Video Endoscopic Sequence 5 of 5.

Snaring the stalk.

Endoscopic polypectomy

Argon Beam Coagulation

The image and the video clip display a diminutive polyp that was removed with coagulation, using argon plasma coagulator (APC).

Small sessile polyps are resected, using several different techniques, including hot and cold biopsy (with and without cautery), hot or cold minisnare, or cold biopsy followed by fulgeration with a monopolar or bipolar electrode.

The monopolar hot biopsy forceps should be used with great caution in the thin-walled right colon. There have been reported perforations and a relatively high rate of delayed bleeding using this device.

When using any type of cautery probe in the right colon, it is important to apply low-power cautery cautiously without pressing the tip of the probe into the bowel wall. Even modest pressure can thin out the wall and increase the chance of perforation.

 

 

 

Multiple polyps

Video Endoscopic Sequence 1 of 37.

Case on Multiple Adenomas (large polyps) of the Rectum.

This 34 year-old male, present four months with rectal bleeding with mucoid secretion, pujo and tenesmus.
Colonoscopy displays multiple ulcerated polyps.

They are located from the pectin line to recto-sigmoid junction, the other segment of the colon were negative to the cecum for colonic lesions.

In order to diminish the size of the large polyps and mass, argon plasma coagulator was used, then a combined therapy will be use to removal them or the patient will need a surgery.

 

 

 

 

Multiple polyps

Video Endoscopic Sequence 2 of 37.

Case on Polyposis of the Rectum.

This mass located in the first rectal valve, has the image of adenocarcinoma but the biopsies have been negatives.
There are several polyps nearby.

Until now the multiple biopsies display tubulos-Villous Adenoma.

Biopsies of polyps to assess for malignant foci are inadequate. Only complete excision permits accurate histological diagnosis.

As a result, polypectomy should be considered as primarily a diagnostic procedure until histology confirms that the polyp has been completely removed.

Multiple polyps

Video Endoscopic Sequence 3 of 37.

Difficult Polypectomy.

To be too difficult to be removed endoscopically.

Generally some criteria are acceptable that Which Patients Should Be Treated Initially With Surgical Resection

(1) polyps that laterally encompass more than one third of the bowel circumference;

(2) those that extend longitudinally over 2 successive haustral folds;

(3) lesions that grossly appear to be malignant (eg, irregular, friable, firm/hard, ulcerated, bleeding); and

(4) polyps that extend into the appendix, a diverticulum, or the ileocecal valve, or otherwise wrap around a sharp fold.

 

 

 

Multiple polyps

Video Endoscopic Sequence 4 of 37.

There are several ulcerated polypoid mass in the rectum.

Large polyps are in fact associated with a higher rate of complications. Some polyps will require surgical removal, but the best gauge of whether a given endoscopist should attempt removal is the degree of experience and level of comfort of that endoscopist.

Multiple polyps

Video Endoscopic Sequence 5 of 37.

This polyps are seen near of the recto sigmoid junction.

Colonic chicken skin mucosa

Video Endoscopic Sequence 6 of 37.

Colonic chicken skin mucosa: an endoscopic and histological abnormality adjacent to colonic neoplasms.

is an endoscopic entity that occurs as a result of fat accumulation in macrophages in the lamina propria of the mucosa adjacent to colonic neoplasms. Small intestine-like microvilli were present in CSM and the pathophysiological implications remain to be elucidated.

CSMrelated adenoma was mainly found in the distal colon, and was associated with advanced pathology and multiple adenomas. CSM could be a potential predictive marker of the carcinogenetic progression of distally located colorectal adenomas.

olonic chicken skin mucosa

 

 

 

Colonic chicken skin mucosa

Video Endoscopic Sequence 7 of 37.

Colonic chicken skin mucosa

White spots are arrangements of foamy cells at the periphery of a tumor. Most frequently found in association with cancers and large adenomas.

A close up of the images, using a magnifying endoscope.

Mucosal abnormalities and molecular changes associated with colorectal adenomas have been reported since colonos-copy began to be widely used for the screening of colorectal cancer. However, the clinical significance of colonic mucosal abnormalities on endoscopy is still unknown. Among the endoscopic mucosal abnormalities in the colon, chicken skin mucosa (CSM) was first identified in 1998 and was described with specific morphologic changes surrounding a colorectal adenoma. CSM is a pale yellow-speckled pattern of colonic mucosa on endoscopy; lipid-filled macrophages in the lamina propria are noted on histopathology.

Colonic chicken skin mucosa

Video Endoscopic Sequence 8 of 37.

Colonic chicken skin mucosa

The image and the video clip display multiple soft polyps.

Multiple polyps

Video Endoscopic Sequence 9 of 37.

Interventional Endoscopy: Using of Argon Plasma Coagulator.

The therapeutic treatment it has been planned to diminish the size of all rectal polyps of our patient. We will try to make so many applications as they are necessary.

Argon-plasma coagulation is based on the transmission of a high-frequency current through argon gas to result in thermal damage. It has been safely and efficaciously used in multiple settings.

Multiple polyps

Video Endoscopic Sequence 10 of 37.

High power setting Argon Plasma Coagulation.

We evaluated the efficacy of a thermal energy source, the argon plasma coagulator, to diminish the size of all rectal adenomas so they will be snare or will be under a combined therapeutic approach.

It conducts monopolar electrosurgical current to tissue via an ionized argon gas stream (argon plasma) that is delivered from a small tube that emanates from the colonoscope.

The argon gas is ignited and charged and cause a superficial destruction of these abnormal blood vessels and stops the radiation related bleeding.

The APC procedure is performed on an outpatient basis and requires only light or no sedation. APC is consider not only effective, but very safe.

 

 

 

High power setting Argon Plasma Coagulation.

Video Endoscopic Sequence 11 of 37.

High power setting Argon Plasma Coagulation.

Argon-plasma coagulation (APC) has been used safely and efficaciously in multiple settings including colon polyp treatment.

The image and the video show the argon plasma coagulating the polipoids tissues. Forward viewing probe is fired in a noncontact fashion to spot weld the lesions.

High power setting Argon Plasma Coagulation.

Video Endoscopic Sequence 12 of 37.

High power setting Argon Plasma Coagulation.

Argon Plasma Coagulation, or APC for short, is a new method of electrocoagulation.

As a result, it allows for the non-contact application of electrical energy to achieve tissue destruction or hemostasis (the ability to stop bleeding).

APC uses high frequency electrical current delivered via ionized argon gas.

This gas, being ionized, allows for the conduction of electricity, thus leading to the term "argon plasma".

High power setting Argon Plasma Coagulation.

Video Endoscopic Sequence 13 of 37.

High power setting Argon Plasma Coagulation.

A forward firing probe is used to fulgurate individual sites.

Firstly, argon gas is emitted from the end of the probe running through the endoscope channel. Next, high-frequency current is discharged from an electrosurgery unit.

When argon gas becomes electrically conductive ( argon plasma ) this allows the current to reach the targeted mucosa of the tissue which is coagulated shallowly and uniformly.

The device is especially effective for the coagulation of hemorrhages on the surface of the tissue.

High power setting Argon Plasma Coagulation.

Video Endoscopic Sequence 14 of 37.

High power setting Argon Plasma Coagulation.

This image shows a large of the mass that has been coagulated.

Colonoscopic polypectomy is preventing colorectal cancer.
Videoendoscopy and new perendoscopic hemostasis techniques make endoscopic polypectomy of large colonic polyps an alternative to the surgical approach.

Video Endoscopic Sequence 15 of 37.

Appearance post two sessions of therapeutical ablation.

Follow up endoscopes have been performed as well as therapeutical approach with argon plasma coagulator.

This sequence from the 15 to 21 is the third one that has been performed.

Video Endoscopic Sequence 16 of 37.

This image as well as the video clip show from the pectin line to the first rectal valve with a mass which have had partially ablation with argon plasma coagulation in addition some briedge are observed from the mass to the pectin line.

Video Endoscopic Sequence 17 of 37.

Rectum in retroflexed maneuver.

Multiple polyps are observed.

Video Endoscopic Sequence 18 of 37.

Rectum in retroflexed maneuver.

An ulcerated polyp that was previously undergone ablative therapy with argon plasma is observed.

Argon Plasma Coagulation

Video Endoscopic Sequence 19 of 37.

The mass of the first rectal valve appears that have been diminish with the two previous therapy with APC.

Argon-plasma coagulation (APC)

Video Endoscopic Sequence 20 of 37.

The image and the video clip shows the new therapy with APC.

Argon-plasma coagulation (APC) has been used in digestive endoscopy since 1991, when a specific electrode that could be introduced through the endoscope channel was designed.

It is a monopolar electrosurgical device that does not need physical contact with tissue, as a high-frequency electrical current is transmitted to the tissue by ionized argon gas.

APC produces superficial thermal damage about 2-3 mm deep depending on energy output and the time current is applied.

Argon Plasma Coagulator Therapy.

Video Endoscopic Sequence 21 of 37.

Argon Plasma Coagulator Therapy.

The non-contact nature of the therapy also allows for the more rapid treatment of large areas of tissues, shortening procedure time.

In addition, although the depth of tissue injury depends on the power setting and duration of application, it appears more limited (0.5 ­ 3.0 mm) than the injury caused by laser therapy.

This offers the advantage, at least theoretically, of a decreased risk of perforation during therapy.

Argon Plasma Coagulator Therapy.

Video Endoscopic Sequence 22 of 37.

The fourth session.

(Sequence 22 to 29), We used Combined Therapeutical methods APC and Mucosectomy.

Large sessile polyps are more likely to have neoplastic foci, with a high rate of recurrence after excision, as well as a higher frequency of postpolypectomy complications such as bleeding and perforation.

For these reasons, alternative ways of destroying residual tissue with a lower percentage of complications have been researched, usually associated with piecemeal polypectomy.
Diverse results have been reported on the use of argon plasma coagulation.

Argon Plasma Coagulator Therapy.

Video Endoscopic Sequence 23 of 37.

More images and video clips of this sequence.

Argon Plasma Coagulator Therapy.

Video Endoscopic Sequence 24 of 37.

A close up magnification using a magnifying colonoscope.

Video Endoscopic Sequence 25 of 37.

The mucosal bridge from the pectin line to the mass has been coagulated.

Argon Plasma Coagulator Therapy.

Video Endoscopic Sequence 26 of 37.

A close up magnification using a magnifying colonoscope.

Argon Plasma Coagulator Therapy.

Video Endoscopic Sequence 27 of 37.

More coagulation with argon plasma.

Argon Plasma Coagulator Therapy.

Video Endoscopic Sequence 28 of 37.

Again more coagulation with argon plasma.

Argon Plasma Coagulator Therapy.

Video Endoscopic Sequence 29 of 37.

Some blocks of biopsies were obtained with the diatermia snare.

Follow-up colonoscopy will be performed soon, as well as the therapeutic approach.

This case will be continued soon, and more images and video clips will be reported here on this clinical case, but long term follow-up will be necessary.

To the last colonoscopy with multiple biopsies, no malignancies were detected, see the histopathological below.

Argon Plasma Coagulator Therapy.

Video Endoscopic Sequence 30 of 37.

Appearance post polypectomy of larges masses of the rectum.

The image and the video display here shows the successful irradication of the first masses displayed in the sequences 2,3 4 of this case.

This image and the video clip represented the status of four treatments with APC and Combined Therapeutical methods with mucosectomy EMR endoscopic mucosal resection.

No malignant evidence has been found until this moment. There are some deep ulcers, The masses disappeared, A follow-up colonoscopy in 3-6 months is advisable to determine whether resection was complete.

Argon Plasma Coagulator Therapy.

Video Endoscopic Sequence 31 of 37.

More images and video clips.

If residual polyp is present, it should be resected and the completeness of resection should be recheched in another 3-6 months.

tubular pattern is shown with chronic inflammation at the surface of the polyp.

Sequence 32 of 37.

A tubular pattern is shown with chronic inflammation at the surface of the polyp.

Colon polyp tubular pattern

Sequence 33 of 37.

There are superficial inflammation and there are not atypias.

Colon polyp tubular pattern

Sequence 34 of 37.

Superficial ulceration of the polyp with purulent exudate.

Colon polyp tubular pattern

Sequence 35 of 37.

Another biopsy with cryptic patern and ulceration of the surface.

Colon polyp tubular pattern

Sequence 36 of 37.

The villous pattern is clearly shown.

Colon polyp tubular pattern

Sequence 37 of 37.

Ulcer of the polyp with inflammatory changes of the crypts.

2000 - 2016 gastrointestinalatlas.com
San Salvador, El Salvador | Contact